NURSES (PAY)

My right hon. and hon. Friends make no apology for returning to this subject of nurses' pay in the light of the extreme urgency of the matter, of the intense public interest that has been shown in and the sympathy for the nurses' case, and in the light of the whole negative attitude of Her Majesty's Government. When this debate was arranged at our initiative we had, of course, no idea that it would take place on the day, to quote today's headline in the Guardian, that the
Dockers Bury The Wages Policy.
It is possible under the Votes that we have tabled to discuss staffing problems of the National Health Service besides that of nurses—for example, the difficulties of physiotherapists, radiographers, and many other sections of Health Service staffs—but as, on the last occasion, I dealt with this at some length, I propose to concentrate this afternoon on the case of the nurses. I want to make it clear that when I use the word
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"nurses" I include midwives whose case is equally strong, if not in some respects stronger.

In the last debate I dealt quite fully with the story of the pay claim, and today I only propose to recapitulate that story quite briefly. I make no excuse for telling it again, because it is a shabby story and it cannot be too widely known.

The first thing that the Committee should remember is that this is not just a normal claim for a wage increase. It is, in fact, a claim for a basic regrading of the whole salary structure of nurses and midwives which has been prepared over a long period. It seeks, among other things, to set right a number of quite serious anomalies which have crept into the structure. If I might mention only one by way of example, nurse tutors are in a very anomalous position at the moment.

The increases claimed are various, and on average are somewhere around 25 per cent. It is inaccurate to say, as The Times said in its leading article today, that some of the increases go up to nearly 70 per cent. The fact is that one increase—in other words, one point of one of the many scales involved where the anomaly is particularly acute—is 49 per cent., but, as I have said, overall it is much more like 25 per cent.

This claim was presented to the nurses and midwives Whitley Council last August. On the very next day there came on to the desk of every Whitley Council chairman the Minister's letter clarifying the policy of the pay pause as it affected staffs in the National Health Service. In this letter the right hon. Gentleman said that claims were to be negotiated, or to continue to be negotiated, on their merits, but he made this reservation, that the timing of implementations remained in the hands of the Government. That much was quite explicit.

In his letter the right hon. Gentleman ostensibly encouraged negotiations, even if in the event he deliberately prevented it. Because six months then elapsed, six months during which no negotiations of any kind took place. Time and again the Whitley Council met to face a completely negative attitude on the part of the management side which said that it had nothing to say—no offer to make.

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I am making no complaint here against the representatives of the hospital authorities who serve on this management side of the Whitley Council, though I would not have been surprised if they had resigned en bloc as a result of what had happened, because they were in the humiliating position of really being puppets, with the right hon. Gentleman holding the strings. They were certainly not free agents, and the right hon. Gentleman has virtually admitted that.

In mid-February the nurses were told that the second phase of the pay pause was about to come into operation, and that their claim would be dealt with in the light of the new White Paper. The staff side was told, on the Minister's instructions, that it could have a 2½ per cent. increase effective as from 1st April. In other words—and this is how the nurses see it with every justification—throughout the period when negotiation was possible—that is from August to February—no negotiations of any kind took place.

They were then made the victims of the second phase of the pay pause, which overtly rules out any negotiations, and which levels out all claims to the 2½ per cent., whatever the individual merits of a claim may be. Then, as the Committee knows, the 2½ per cent. was totally and unanimously rejected by the Staff Side of the Whitley Council, and this is where the matter rests now.

There is provision in the Whitley machinery of the Health Service for disagreements between the two sides, once they are registered as disagreements, to be settled by arbitration at the Industrial Court. This, of course, is if the staff side wishes. About a week ago a number of political correspondents of several newspapers ran a story that the dispute with the nurses was about to be settled; that the nurses would agree to go to arbitration, and that this course was, or would be, welcomed by the Minister. There were even rumours that as a result of this course the nurses would be offered something substantially better at the end of the day than the 2½ per cent. that they had been offered.

The stories in the different newspapers can hardly be dismissed as coincidental. They bear all the marks of kite flying, and one is driven to the assumption that
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they were inspired by one side or the other. Since it was not the nurses who inspired the stories—there has been an official and categorical denial that the nurses were even contemplating arbitration in the present circumstances—it looks very much as though the right hon. Gentleman might have been trying to take some steam out of the campaign for the nurses' claim, which had become distinctly uncomfortable politically both for him and for his Government.

I sympathise with the unwillingness of the staff side of the Whitley Council to consider arbitration, because what guarantee has it that in these circumstances arbitration would be free and unfettered? And if it is not free and unfettered, what is the point of going there? Indeed, there is every indication that arbitration would be nothing of the sort. First, there is the right hon. Gentleman's circular, in which he has made it perfectly clear that where arbitration was concerned the timing of the implementation of the awards that might be made by the Industrial Court was specifically removed from the scope of arbitration. In other words, any award that might be made by the Industrial Court could quite easily be postponed by the right hon. Gentleman to the Greek Calends, and as far as the Minister is concerned that is a very appropriate date.

That is not, I believe, the understanding of the staff side. It has no confidence in the arbitration procedure in the light of this phase of the Government's wages policy.

Secondly, there is abundant evidence that the right hon. Gentleman and his Department are continuing to rest their cases that go to arbitration—that is the management side case—entirely on the pay pause argument, and it is clear that the Government at least expect the Court to be guided by national policy considerations rather than by the merits of individual claims.

When we last debated this matter, the right hon. Gentleman, in replying to the
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case that was deployed from these benches, rested the defence of his actions on two legs. On the first point, he tried to show that statistically the position of nurses in hospitals and in the Health Service generally was far from being as serious as we had represented; indeed, that on the whole it was highly satisfactory and that there was nothing to worry about.

Secondly, the other leg of the right hon. Gentleman's argument was that there was an absolutely overriding need to maintain the pay pause policy in the national interest and not to breach it, whatever the arguments might be in favour of any special or exceptional case. I should like to examine these two sets of arguments separately.

First, on the question of the shortage of nurses, we all realise that there are more nurses in the National Health Service than there were, say, ten years ago. The Minister produced figures to show that. Incidentally, I hardly think that we should pay very much attention to the Minister's figures since the speech he made a week ago to the Institute of Hospital Administrators at Cardiff, in which he confessed the gross inaccuracy of National Health Service statistics. He may well be right about that, but I think that he can hardly absolve himself or his five or six predecessors from the responsibility for that situation.

But did the Minister wish to convey that we have enough nurses? I should like to ask why he did not mention the enormous increase there has been in these ten years or so in the complexity of the nurses' task, an increase of complexity which arises from the development of modern treatments and techniques in nursing? Why did he, for example, ignore the greater intensity of the nurses' work, a matter which was raised by one of my hon. Friends at Question Time today, the greater intensity which arises from the increased bed turnover which has been going on in all hospitals in that period?

Why did the right hon. Gentleman not mention the reduction in hours which was negotiated some years ago from 96 hours a fortnight to 88 hours a fortnight? All these factors, every one of them, creates a demand and a need for more nurses, so that a mere numerical
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calculation and comparison between the nurses we had ten years ago and those we have in the hospital service today, even if the figures are accurate, Just are no answer to the nurses' case.

The right hon. Gentleman does not accept what was put to him from this Box, that there are 25,000 vacancies for nurses in the hospital service, though he is not in a position to refute it; he cannot produce any counter figures, so to speak. He also believes that the figure which was quoted of 10,000 hospital beds unoccupied for lack of nursing staff is an exaggerated figure, but, again, he acknowledges that he cannot give an accurate one.

I do not want to argue the case today on these figures. I am prepared to stick to facts and figures which are common ground between the right hon. Gentleman and myself. He does not deny—because he mentioned this in his speech on 27th March—that student nurse recruits fell in numbers appreciably last year compared with the year before. I am sure that he is also aware that in 1961, for the first time since the war, the number of trained nurses in the hospital service, as well as the numbers of student nurses, fell. That is a very serious situation indeed, particularly when we are getting more and more student nurses in proportion coming from overseas countries.

What it means is this, that we are just not renewing even our present inadequate complement of trained nurses, and unless this trend is corrected this situation must lead to a very serious staffing crisis in the fairly near future. Far from being corrected, this trend must have very seriously worsened during recent months. Unfortunately, the figures are not yet available, but the Minister's miserable response to this pay claim of the nurses, with all the attendant publicity, must have had a simply devastating effect on the recruitment of student nurses and, indeed, on the wastage both of student nurses and trained nurses in the service.

The evidence is coming in fast. I have had plenty, and I am sure that hon. Friends of mine and hon. Members opposite will have had it, too. I should like just to give the House the facts about a single hospital in south London.
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They were given to me by the matron. This is all dealing with trained nurses.

The matron says that one staff nurse has emigrated to Australia; two theatre sisters are preparing to emigrate; another staff nurse has just taken a post with a television company answering inquiries in the reception department; an excellent male staff nurse has joined the Merchant Navy where he is getting £52 a month net with everything found and 30s. a day for subsistence when he goes ashore; another theatre staff nurse has gone into busines; two male staff nurses have left, one of whom has taken a better paid job in a supermarket because he recently married and could not keep his wife on £6 a week.

As for students, she says that in a group recently taken into the preliminary nurse training school, out of 33 students only one was English, the rest were from abroad. I should like to take one other example, which comes from a hospital in Scotland. There, the matron said that the very day she was writing the letter she had on her desk resignations from three trained nurses. Two of them were emigrating to Canada before the end of the month, and the third was going into the police force.

Can we be surprised in the light of recent events that this sort of thing has been happening? If that is the effect which these happenings are having on trained staff, what must be the effect upon the potential recruits to the service? I leave that to the right hon. Gentleman to calculate.

Now I turn to the other leg of the Minister's argument in the last debate, what I may call the pay pause argument. I should like to quote to the House what he said on 27th March:
For this is not a partial policy. This incomes policy is not a policy for one section of the community. It is a policy for the nation as a whole, and it is a policy which could not be carried through and could not succeed if the Government, where the Government themselves have the responsibility, authority or influence, did not act and were not seen to be acting in accordance with their own policy."—[OFFICIAL REPORT, 27th March, 1962; Vol. 656, c. 1101.]
Compare this utterance, so uncompromising, and so typical of the night hon. Gentleman, with subsequent observations on the Government's wage policy
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by some of his colleagues. Only a fortnight later we had the Financial Secretary to the Treasury, in the Budget debate—I understand that the Financial Secretary is to wind up this debate—saying:
But, of course, the Government realise that an absolutely flat level of pay increases is not something that could be maintained in the long run. It would not be fair to individuals, nor would it be sound economics. We must, therefore, arrive in due course at some means of providing for special circumstances in which a case can be made for a divergence from the general rule."—[OFFICIAL REPORT, 11th April, 1962; Vol. 657, c. 1338.]
Then we had the speech of the Minister for Science to the Cities of London and Westminster Conservative Association, last Monday. Lord Hailsham, in that speech, went further still. He told his audience:
Some professions, in particular those which demand long periods of training and a high degree of personal devotion and self-sacrifice"—
and he could hardly, without actually using the word "nurses", have described the nursing profession more accurately—
have been persistently under-valued in the past and must be better valued in the future. This part of the exercise is a difficult one because in the intermediate phase of the pause it is sometimes they who bear the brunt of the 2½ per cent. But we never intended and never said that 2½ per cent. was to be absolutely rigid, still less that it was to be permanent. We must get ourselves off this hook as soon as possible.
Just one more sentence to end this quotation:
This is the age of the qualified man and woman, and the Conservative Party is and must continue to make itself pre-eminently the party of the qualified, the self-sacrificing and the public-spirited.
Is the right hon. Gentleman going to get himself off the hook?

And, finally, we had the speech of the Chancellor of the Exchequer to the Cutlers at Sheffield, in which he adopted a tone of almost manic optimism about the country's prospects. Really, the economic climate as he described it is hardly consistent with the sacrifices which the right hon. Gentleman is demanding of the nursing profession in the national interest.

So much for Ministerial utterances. Now I should like to turn to Ministerial actions since the last debate, and the first thing that I want to look at is the
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recent settlement in the docks dispute. Of course, it will be argued by the right hon. Gentleman that the dockers are not public servants, but was not the Minister of Labour involved throughout the final stages of those negotiations? It was very unclear today exactly what rôle he was trying to convince the House he had played or failed to play in those, but does anyone in this House believe that this settlement, which is described by The Times today as between 8 per cent. and 9 per cent. overall, could have been reached without the approval of the right hon. Gentleman the Minister of Labour?

I should like to repeat what I have already said, that it was my duty, as Minister of Labour, when the negotiations and discussions between both sides broke down, to bring those two sides together again, but I was not a party to the subsequent negotiations which took place.

In that case how does the right hon. Gentleman reconcile the contracting out of the pay pause? I leave it to the House to decide, to use its own judgment, whether it thinks that, if the Minister of Labour had told the dock employers flatly that they could not agree to any settlement in excess of the 2½ per cent., this dispute would have been settled.

This settlement carries infinitely more damaging implications for the whole rickety structure of the Government's pay pause policy than any settlement which the Minister of Health might have reached with the nurses. Why, then, has the Minister been so intransigent? Was it not because the bargaining position of the nurses was that much weaker? Was it perhaps because still only about half of the nursing profession are members of their trade unions?—though I must say that the right hon. Gentleman is proving himself to be the most successful recruiting agent yet. Do the nurses have to throw overboard their instinctive and highly creditable dislike of direct action and actually threaten a strike, like the dockers, before their equally just demands are taken seriously by the Minister?

But if the Minister does not like the example of the dockers—and I can well
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understand that he does not—perhaps we can take another example nearer home, one which involves a profession, not the nurses in this case, but the doctors. What is the right hon. Gentleman's answer to the new pay scales which have just been announced for doctors in the three Armed Services—new scales which involve increases at the lower end of about 100 per cent., plus or minus? Indeed, the new scales are so generous that a Service career now offers a doctor a substantially better financial reward than does general practice, with considerably less expenditure of effort on his part.

I ask the right hon. Gentleman, was this decision taken without reference to the Minister responsible for the National Health Service, or was he consulted about it before the decision was reached either by the Minister of Defence or the Cabinet? What can one make of a Government who do this kind of thing at a time like this? Of course, the Prime Minister said in reply to a Question last Thursday that we needed the men. Do we not need the nurses? This is not a policy of principle. If one breaches it because one needs the men, it becomes a policy of pure expediency.

The Government's wage policy is in ruins. If the right hon. Gentleman still thinks that he can legitimately try to impose it on the nurses, it is time he began to think again. Or does he want to be the Casabianca of this Government? Will he still be standing, tense and pale, on the burning deck when all his Ministerial colleagues have fled? He would do far, far better to forget those false heroics and swim for it now before the ship sinks under him.

Public sympathy and support for the nurses in this claim has been on a scale quite unprecedented in the whole history of pay disputes. If the right hon. Gentleman does not believe that, let him ask any candidate in the recent by-elections. But, in addition to the general public support, something quite unusual, almost unique in recent history at any rate, has been happening on the industrial front. I refer to the wave of token stoppages and sympathy strikes, often accompanied by protest marches and even gifts of money, that have been taking place in firms of varying nature—some of them small, some of them the
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largest firms in the country—in sympathy for the nurses.

I know that the nurses' leaders and, indeed, the General Secretary of the Trades Union Congress have condemned these demonstrations of sympathy, and I have no wish to enter into the rights and wrongs of them. I just want to record the facts. Here we have group after group of workers making spontaneous gestures, often with loss of wages to themselves, and in one instance involving even a postponement of negotiations for their own pay claim, in order to demonstrate publicly their support for this profession which can do so little for itself in this way.

As The Times put it in its leading article today:
… although public support has sometimes taken irrational and dubious forms its sincerity cannot be disregarded.
I do not think that anyone would question the sincerity of a letter which the right hon. Gentleman received last week, and of which I also received a copy. Indeed, it is so remarkable a document that I should like to read it to the House in full. It is not very long. It comes from a firm in the glass industry with about 500 workers. It is addressed to the Minister of Health and says:

§
The operatives in this company, believing that token strikes do not either properly or effectively help the cause of the nurses, have on their own initiative decided that they will show their sympathy in a practical way by each donating an hour's pay to the funds of the Royal College of Nursing for use in their campaign. The office staff and the directors have decided to give support by a similar contribution from their salaries. Furthermore, the directors have resolved that the company will double the amount by sending a sum equal to the total contributed. It is hoped that this action, taken by over 500 people representing a small cross-section of the community, will demonstrate the strength of feeling which exists in favour of the nurses' claim. We urge that this claim should be considered as one not coming within the Government's general wage policy and that a generous settlement should be effected."

§
That letter bears 18 signatures, including the senior shop steward and the works council representative for every group of workers in the firm, and it is signed at the bottom on behalf of the directors by the managing director of the firm.

§
The Press has been almost unanimous in its support of the nurses' claim and in its strong criticism of the right hon. Gentleman's attitude. In this, I include newspapers like the Sunday Times—I will not weary the House by reading its editorial of a week ago—newspapers which normally support Government policies. Indeed, the Government have no friends at all in this policy which they have adopted towards the nursing profession.

§
It is very easy to be sentimental about the nurses and the nursing profession. I suppose that the Florence Nightingale tradition, "Emergency Ward 10" and all this talk of vocation contribute to obscuring the essential features of a nurse's job, which is not in the accepted sense a pleasant one. I think that the Committee, in considering this matter, ought to take a rather more realistic view. I would remind hon. Members that the nurse is intimately and continuously concerned with blood and death and the more basic functions of the human body, that the psychiatric nurse spends much of his or her time amongst potentially violent and dangerous psychotic patients, and it is because of these things, just as much as in spite of them, that for those who can take it it is such a deeply satisfying profession.

§
By any standards that the House of Commons can apply, this is essential work, and yet we as a community pay a staff nurse in a London hospital for this work the sum of 5s. per hour, which is less than the B.B.C. pays its office cleaners. To be a staff nurse has involved three years of arduous training. Indeed, it has involved more than that. It is three years of hard and tiring work on top of which training has been superimposed. A ward sister, with all her responsibilities, after seven years in the job is still getting only £16 per week gross, with substantial deductions. That is the essence of the nurses' case.

§
Has not the right hon. Gentleman done enough damage to the morale of the National Health Service, to the whole Whitley system of wage negotiation and to his own reputation? How much longer is he going to hold out? He knows that he will have to give way in the end. He will have to allow this claim to be freely and honestly negotiated on its merits.

§
In a speech the right hon. Gentleman made over the weekend he said that we must judge a thing by the harsh test of "Does it pay?" I do not know whether he intended this to apply to the National Health Service. If he did, the answer is, emphatically, "Yes, it does pay." The National Health Service pays incalculable dividends not only in terms of human happiness and human health, but in economic terms, too, in getting people better and back to productive work. It is time that the Government gave those who work in the Service a fair deal.

In rising to reply to the hon. Member for St. Pancras, North (Mr. K. Robinson), I would begin by echoing some his closing words about the place for sentiment and the place for eschewing sentiment in this matter.

Of all questions of pay, one which concerns the pay of nurses was bound to attract, naturally attracts and rightly attracts, public interest and sympathy. But this fact does not absolve us here in this Committee from trying to judge that claim and this issue in the light of facts and of economic realities and of policies which affect the national interest as a whole.

The hon. Gentleman poured scorn upon the Government's incomes policy. But the basic proposition of that policy cannot be challenged. It is that a rise in incomes which outstrips production has consequences from which all are bound to suffer, not least professions like that of the nurses themselves, which will always be at the tail of the rat race of inflation. The importance of this policy, founded upon this unchallengeable proposition, is, therefore, overriding, not only in the interests of the nation at large, but, coming nearer home, in the interests of the professions.

It is a condition of success of this policy that the Government themselves, where they have control or influence over incomes, should be seen to behave as all should behave, and the truth of this proposition becomes not weaker but stronger if that standard of conduct is not everywhere adhered to. [HON.MEMBERS: "What about the dockers?"] This is not so simple a matter as the mere application of some flat-rate percentage formula, but the
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White Paper on Incomes Policy: The Next Step made it clear that in the present phase only the clearest and strongest reasons could justify increases which are appreciably in excess of 2 to 2½ per cent.

The White Paper itself referred to one possible class of such reasons, a class which has been much associated in the public mind, in discussion and, indeed, in the hon. Gentleman's speech, with nursing. It said:
A shortage of labour within the particular industry or firm would not of itself warrant an increase in pay. It is only where the building up of manpower in one industry relatively to others, or the prevention of a threatened decline, is plainly necessary that an increase on those grounds could be justified.
A shortage of nurses, even in the hospital service—it must not be overlooked that there is a considerable volume of nursing outside the hospital service—is something not so easy to define or to measure as might be supposed. Statistics of vacancies at Ministry of Labour offices and of beds unused for lack, of staff, are, as I have said before, and as I think the hon. Member virtually admitted, no real and reliable guide.

The Ministry of Labour figures for vacancies undoubtedly contain large numbers of duplications and include vacancies which have been filled. The figures of beds unused for lack of staff certainly include large numbers of beds which are out of use for very different reasons. But, certainly, when the job, which has now been put in hand, of getting the statistics into order and revising the definitions so that the statistics do the work for us that is required, is finished, I should be surprised if it turned out that more than a few hundred beds which were otherwise available were out of use for lack of staff.

Now that the long-term physical capacity which the hospital service needs has been assessed in the Hospital Plan, the next task—and one which has already begun—is to work out the complements of nursing and other staff which are really appropriate in a modern Service under modern conditions. These must have regard not only to the increasing intensity of patient care to which the hon. Member referred, but also, on the other hand, to all that can be done by organisation and technique to relieve
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nursing staff of unnecessary or unskilled work and to multiply the power of all kinds that is at their elbow.

There need be no dispute that there are areas and fields where an absolute increase in numbers will be necessary, but it would be quite wrong to see the improvement of the services to patients in terms of a multiplication of nursing staff. Indeed, preoccupation with mere numbers could militate, as ease of recruitment has done in the past, against those improvements of organisation and technique, some of which might be revolutionary, which will enable a given amount of nursing time to produce a greater amount of patient care. While the estimate of ultimate need is thus difficult, there is no doubt about the figures or the facts of staff in post, or the trend which they disclose.

What the right hon. Gentleman is describing is, in effect, an increase of production for the labour of the nurses. In that case, is he not justifying an increase of salary to compensate for that increased production?

I am talking about the prospective need and, if there is a deficiency, the prospective deficiency of nursing staff and the factors which have to be weighed in arriving at a view about that. While the estimate of this need is difficult, there is no doubt about the figures of staff in post, or the trend which they disclose.

As I told the House in the debate on 27th March, on the basis of the figures up to last September, all branches of nursing and midwifery showed and continued to show a strong upward trend, marked and continuous, a trend which had characterised the whole period of the preceding five years or more. This is a movement which has continued uniformly year by year—in years like 1958 or 1960, when there was no increase in pay; in years like 1959, when increases ranged from 5 to 25 per cent.; or 1961, when there was a further increase of 5 per cent.

The figures up to the end of March, this year, are now available and the Committee, including the hon. Member for St. Pancras, North, who predicted that a devastating effect would be dis-
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closed in these figures, will be glad to know that they show that this trend continues. There is not a branch of staffing, trained or untrained, whole-time or part-time, nursing or midwifery, mental or general, where staff in post are not again more numerous than a year before. I would mention the single exception. It is the exception which proves the rule. There was a drop of 23, or one-third of one per cent., in the number of mental nursing students. But—and this is why it is the exception that proves the rule—many hospitals are gradually raising standards of entry, a policy which will pay dividends in reduced wastage.

The right hon. Gentleman is talking about increases in staff, but is it not a fact that the Minister lays down an establishment in each hospital in relation to the services required, and that the difference between the establishment and those in post is regularly submitted to the Ministry? I will give him one example with which he can deal and which comes from a hospital with which I am concerned. It is a maternity hospital in Liverpool which, on 26th March, 1962, had 185 beds while the midwifery, sisters and staff—

The Deputy-Chairman

Order. The hon. Lady rose to ask a question, and she should confine herself to a question and not make a long interruption.

I am glad that the hon. Lady has mentioned establishments, because there is a great deal of misunderstanding. Establishments are not approved by my Ministry and they differ in different parts of the country. They date from different times and they represent different estimates. It is only by means of the study of staffing complements, which I mentioned earlier, and by looking to the future, that any rational basis for the assessment of need can be reached.

I have asked the Committee to take note not only of the trend which we have
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seen in the nursing staffing of hospitals over recent years, a continuing and continuous trend, but of the fact, as I have just said, that it has continued in the last six months as in the previous six month periods going all the way back. The uniformity of this increase and the fact that it embraces all grades, trained and untrained, is, incidentally, a refutation of any suggestion that the trend can be dismissed as simply representing an increase in the small but welcome over-seas element in our nursing staff.

I do not put this before the Committee as an argument that the existing salaries and rates of pay are necessarily right or that the structure is necessarily right. I do say that these are not circumstances in which it would be right or possible far the Government to recognise a clear and urgent case for a major exception from their own incomes policy in their own field of influence. It is in that context, and not as representing some abstract valuation of the services of our nurses, that the advice which my right hon. Friend the Secretary of State for Scotland and I gave to the management side of the Whitley Council—that the amount of any offer in present circumstances should be limited to an increase of 2½ per cent. on the salary bill—was right and necessary.

The Committee will note that I have not used the rising staff figures and the good recruitment as an argument to the effect that present salaries are necessarily right. Certainly, in relation to the training allowance of students and pupil nurses and to the salaries of unqualified and part-time staff, such an argument would have considerable force. Indeed, if the job, its conditions and its pay taken altogether, were not attractive, it is impossible that people would be joining it, or returning to it like the part-time staff, in increasing numbers.

This argument, however, loses much of its force when we come to trained and experienced staff who have dedicated themselves to nursing as a career. It would be unfair to argue that because they choose to stay at their posts and their numbers even rise, this therefore proves that their salary and their career structure is wholly satisfactory as it stands today. My right hon. Friend the Secretary of State for Scotland and I therefore welcome and encouraged the
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decision which the management side took some days ago to make a new initiative.

The staff side, it will be remembered, rejected the management side's offer in March and has not sought any further joint discussions since. It was only proper that the management side should wait to see if the staff side would decide to avail itself of the independent arbitration which it has always known was open to it. Perhaps on this point I should correct a slip into which the hon. Member for St. Pancras, North fell. He said that the date of the implementation of an arbitration award was still withdrawn from the subject of arbitration. That is not so for any date subsequent to 1st April, 1962, as he will see if he refers to paragraph 2 (d) of the White Paper.

I am grateful to the right hon. Gentleman for his correction of my slip, for which I apologise. Will he tell the Committee whether it is now open to the Industrial Court to deal with claims which come before it on their merits, without having regard to overriding considerations of the Government's wages policy?

I must refer the hon. Gentleman to the clear statement of the Government's position in this matter which is set out in the White Paper, as he knows perfectly well. I thought it right, and I am sure that he would agree, that I should correct a misapprehension about the withdrawal of the date from the subject matter of arbitration.

The hon. Member discovered a mare's nest when he imagined that a kite was being flown in this matter a week back, since it always has been common ground and common knowledge that independent arbitration, as referred to in the White Paper, was open to the staff side if and when and at any time it asked for it.

But it would be a pity now, if, after two months have passed, contact between the two sides of the Whitley Council remained broken. The chairman of the management side, with the warm approval of my right hon. Friend and myself, is today writing personally to his opposite number on the staff side to suggest that the two sides should resume contact and engage together in a study of the salary structure to see what changes and improvements can be
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made in it within various limits of cost, and what relative priority should be attached to these changes.

Any resultant agreement would no doubt have to be implemented by stages, for the limits of cost for this purpose would not, of course, be confined to a total of 2½ per cent. of the salary bill. But there is everything to be said in favour of this essentially creative job being started now. I cannot believe that there is anyone, on either side of the Committee, who would not welcome this initiative of the management side and hope that contact can be resumed.

I feel sure that this will be the sense of general opinion outside, and that the Royal Colleges and other nursing bodies, who have been so jealous for the good name and responsibility of their profession, which, as a whole, has carried itself in all this controversy with great dignity, will lend their great influence in the same direction.

Can the right hon. Gentleman clarify one point? When the negotiations broke down, in so far as there were any negotiations, the position was that the staff side had left a claim with the management side for a detailed reassessment of the grading structure. Is the management side now making a specific offer in reply to the claim it has had from the staff side?

As I told the House, it is proposing that the two sides should resume contact and engage in a study of the salary structure to see what changes and improvements can be made in it within various limits of cost, and what relative priorities should be attached to these changes.

There stands on the Order Paper a Motion in the name of my hon. Friend the Member for Maidstone (Mr. J. Wells). It carries the names of about 100 right hon. and hon. Members from Both sides of the Committee and says:
That this House welcomes the steps taken by Her Majesty's Government to modernise hospitals and to improve working conditions of the nursing profession, and notes the improvement in recruitment of nurses, but urges Her Majesty's Government to review, as soon as economic circumstances permit, the salary structure of the nursing and midwives profession.952
The Government believe that, while the overriding requirements of the national incomes policy must be maintained, the work of this review could and should begin without delay on the lines I have indicated. They trust that it will go forward to results which will be beneficial to the future of the nursing profession and the patients that it serves.

While the Minister was speaking I was watching the expression on the faces of the right hon. and hon. Gentlemen opposite. They showed as much disgust at the Minister's remarks as we feel on this side of the Committee.

The Minister quite rightly said that we must have economic viability and that it would be wrong to allow incomes to run away with the result that any improvement in pay brought little benefit because of inflation. If the Government will examine their own incomes policy they will see that they have been unfair to that section of society which comes within the lower income group. In the hospital service what is equivalent to the maximum wage for ancillary staff council employees is about £624 a year.

I should like to point out what has happened since the Government have been in power. After taking into account Income Tax and National Health Insurance contributions, a person earning £624 in 1952–53 received £608 17s. 10d. out of his earnings. In 1962–63, he will receive less—£606 14s. 2d. On the other hand, a person earning £5,000 a year, who received £2,581 in 1952–53, now gets £3,656, or an increase of over £1,000. A person earning £10,000 a year in 1952–53 got £3,529 19s. 4d., but today he gets nearly twice that, £6,094 0s. 4d.

How can the Minister talk about an incomes policy by which he tries to prevent those employed in the National Health Service from getting an increase in pay when, by the Government's action, those in the higher income groups have received much more income? It is for this reason that strikes are threatened and that the nurses have been demonstrating.

I was glad to hear from the Minister that there is a possibility of the settlement of the nurses' pay problem, but if
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this happens I should like the nurses to remember that it was secured for them by organised labour and not by any generosity on the part of the Government.

The right hon. Gentleman knows that I am on the side of the nurses in this matter. It is not only organised labour. I am authorised to speak for the Royal College of Nursing, and I have their letter in my possession about the proposals which my right hon. Friend has put forward. It has been a joint effort. The right hon. Gentleman should not forget it.

I hope that the nurses will remember this when the struggle occurs a little later, as it will, over the pay of other Health Service employees, and that they will give the same assistance as organised labour has given them on this occasion.

In the National Health Service generally, including the administrative and clerical workers, professional and technical workers, and the ancillary staff, all pay is too low and should be improved. Before coming back to the House recently I represented the National Union of Public Employees on some of these Whitley Councils on which we negotiate settlements in the Health Service. As far as I can see, the Government are seeking to destroy these Whitley Councils, and that would be most unfortunate because they have been the means of creating harmony and good spirit in the Health Service and making administration much easier than it might otherwise be.

The Whitley Councils have developed over the years from previous negotiating machinery. In the case of ancillary staff there was the Mowbray Committee, the forerunner of the present Ancillary Staffs Council. The creation of the Administrative and Clerical Staffs Council which exists today came out of three types of
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organisation because of different ownerships of the hospitals, The Nurses and Midwives Council arose out of the Rushcliffe and Guthrie Committees. All of these bodies were gradually built up over a period, and they have established an association which brings stability into this service.

It is interesting to reflect that at the regional level, where the Minister of Health's representative is given power, they work exceedingly smoothly and satisfactorily. It is only when we come to the national level that the machinery breaks down. This is not the fault of the management side as a whole, because those who represent the different local government associations, hospital committees and regional boards would reach an understanding; they are just as dissatisfied as is the Staff Side about the constant interference in the negotiations by the Minister of Health and the Treasury.

I was present at a Whitley Council meeting on 16th January when we were dealing with the pay of almoners and psychiatric workers, a claim for which had been outstanding for many months. Negotiations started before the Chancellor of the Exchequer introduced his pay pause, and we were told privately by some members on the management side that a settlement was in sight. Both sides have their meetings before the full council meeting. While the trade union side was meeting, the Chairman and Secretary were called out and they were told that there had been a message from the Cabinet room to say that negotiations must stop—and stop they did. The trade union side was very disappointed, but the management side, too, felt it and apologised to all of us.

The Government are making a mess of Whitley Council machinery by treating these very responsible people in this way. What ought to happen is that the Whitley Councils should be given power by the Government to act. They can do it. Why not? The Minister himself appoints the management side representatives. Is it suggested that he appoints irresponsible people? Those who attend these meetings have had experience of negotiating in the hospital service for a long time. They have never thrown away public money. They have been very jealous in their
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scrutiny of the public purse. I think that the Minister of Health should do all he can when a Whitley Council meets and reaches a decision, to give it his support instead of caving in as soon as there is pressure from the Treasury.

It is rightly thought by many hospital workers that the only reason that the Whitley Council machinery exists today is to enable the Government to get cheap labour into the hospital service. I appeal to the Minister to give these Whitley Councils the full responsibility to which they are entitled, because if he fails to do that the Whitley Council machinery will break down and we shall have a position in which we do not have harmony and a good spirit and in which there is constant interference with good administration.

My hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) said that he was dealing specifically with the question of nurses' pay. I should like to add my support for an increase in nurses' pay. I remember that on one occasion when I had been to a hospital meeting a group secretary told me that he had seen two nurses day after day on their rest day sitting in the lounge or walking about the grounds and he asked them why they did not take the opportunity to go to London to see the sights. They had replied that they would like to do so, but that they had not the money. He loaned them the bus fares in order that they could go to London to see the sights. This is one case, and it could be repeated over and over again.

The Minister suggested that the staffing position among nurses was not too bad. In some cases that may be so, but if he takes particular areas in the country he will find that it is very bad. In Yorkshire, part of which I know, there is one hospital where, in spite of the fact that the trade unions have succeeded in getting an 88-hour week, the staff work 96 hours a week. The Minister can imagine what would happen in some other industries. Because they like to see the smiles on the faces of their patients, these nurses are willing to work these extra hours. It is a shame to impose on these people who are such good public servants and who are giving of their best. Certainly in this hospital additional staff is required.

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In a large mental hospital in Yorkshire ten years ago they had 193 trained staff. Today they have 129. Is there any wonder when a male nurse gets only £9 a week. One of the ways in which nurses' duties are eased is by the employment of ward orderlies. Unfortunately, in an earlier debate the hon. Member for Orpington (Mr. Lubbock) gave the impression that these people were extremely well paid when, in fact, they get £7 6s. 6d. a week, which is under 3s. 6d. an hour.

They get that only because they are prepared to do shift work and to work on Saturdays and Sundays. It is very difficult to get anybody to do that.

Nurses, too, should get this enhanced rate, and if they were members of a trade union they would probably get it. To the extent that they belong to trade unions, the trade unions concerned are pressing for exactly these conditions, and the more support that nurses give to the trade unions the sooner they will get the rates paid to ward orderlies, who were recruited originally to prevent trained nurses from having to do many of the menial tasks.

They were able to do the sanitary rounds for certain nurses, nursery care for children, the preparation of baths for convalescent patients, scrubbing tables and lockers and linen cupboards, washing ward lamps and cleaning sinks. Many of these things have to be done by nurses because there are not sufficient ward orderlies.

In many instances the position of ward orderly is being abolished because contract labour has been introduced into the hospital service. This is wrong and, in the long run, uneconomical. It is said that workers under contract labour have to do specific jobs and can do no other than canteen or domestic work or helping out with some other section. These workers are not allowed to mix freely, and this is preventing the ward orderly service from developing—and this means that the Minister will have to find more and more nurses.

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There are other ancillary grades who get below what is called the average earnings in industry. The gross pay of a general porter is £9 12s. 8d. a week; the deductions are £1 0s. 7d., and his take-home pay is £8 12s. 1d. Out of this, a typical porter has to pay £2 12s. 6d. rent, 9s. fares and 17s. for fuel, gas and electricity, which is a total of £3 18s. 6d. This leaves him with £4 13s. 7d. plus 8s. family allowance, a total of £5 1s. 7d., to keep himself, his wife and two children in food and clothes, to provide for holidays and insurance and to meet hire-purchase commitments and, indeed, to do many other things which he cannot do because he has not the money.

The basic pay of a male nursing ancillary is £9 19s. 2d. a week. If these people work on shifts all the week and work on Saturday afternoons and Sundays, they get an extra £2 10s. This makes gross pay of £12 9s. 2d., but there are deductions which bring the figure down to £9 19s. 2d. Out of this he has to pay—rent £2 15s. 3d., fares 12s., fuel, gas and electricity 15s., which is a total of £4 2s. 3d. This leaves just over £5 a week for food, clothes, hire purchase and replacements in the home. It will be seen that there is little or nothing left for what might be termed "inessentials".

A telephone operator receives £11 4s. 8d. Deductions are £1 2s. 7d. The take-home pay is £10 2s. 1d. The rent is £2 5s. 8d.; fares are £1 14s.; food at work is 11s. 3d.; fuel, gas and electricity are 17s.; insurances are 6s. It can be seen that the person who provided me with the details of this budget can hardly make ends meet in keeping himself, his wife and his two children in food, clothes and other essentials.

The Minister must face the fact that the Service for which he is responsible is grossly underpaid. As the Minister he should be making the strongest possible representations to the Treasury. As an ex-Treasury Minister he should be better informed and knowledgeable and able to do this. If he was doing his duty as a conscientious person, he would be stressing this now and continuously, instead of coming here this afternoon and speaking as though he were winding up the debate representing the Treasury
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instead of his great Department, the Ministry of Health.

If it was not for foreign labour, the hospital service would fall down. I am the last to complain of the wonderful people who are doing a good job, but I am reminded of an employee in a hospital who said to me the other day, "You know, at the rate we are going the only people who will speak English in this hospital soon will be the patients." The Minister cannot be satisfied with a situation in which a person concerned with the care of a patient cannot speak the language, perhaps at a time of great danger, when so much will depend upon it. It is up to the Minister to ensure that people who are qualified and able to do the work are recruited. Many people in this country want to do it, but the attractions of outside industry are so great that they have to go there to get enough pay to provide for their wives and families.

It is not only pay. It is also conditions of service. Many hospitals are very old. The amenities are inadequate. I have been into a porters' rest room where they have to change their clothes and eat. It is more like the Black Hole of Calcutta. This is not the fault of the hospital management committee, which wants to build a new rest room. The Minister prevents the committee from doing so. He has prevented this committee and others from improving hospitals over a long period. Now there is a new excuse why it will not be done, "We have the hospital programme. This hospital is to be pulled down. A new one will be built." In the meantime, these employees have to live in these wretched conditions, maybe for years to come.

The Minister should be devoting his attention to salaries, wages, conditions of service, and to ensuring that these people are better treated. They do not go on strike. They are dedicated to their work. They know that if they left the hospital it would not be the Minister of Health who would suffer. It would not be the management. It would be the patients. At no time would any hospital worker do anything to damage the health of a patient.

It is for that reason that the Minister, and, indeed, Parliament and public opinion as a whole, have a great obliga-
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tion to ensure that these men and women, who do not use their organised strength to strike, get a square deal. It is time that the Minister played his part in ensuring that they do.

I am grateful for the opportunity of taking part in the debate on this important subject. It is the first time that I have intervened in a debate on a subject coming within the ambit of the National Health Service since I left the office of Minister of Health.

There is in the House of Commons a seemly and satisfactory convention that when Ministers are succeeded in office by members of their own side they do not normally intervene in debate during the initial period of their successor's term of office. I have fully honoured that convention, because it is now nearly two years since I left office. In my case it has been the easier to abide by the convention because of the genuine regard that I have long had for the high quality and devotion to the public service which are characteristic of my right hon. Friend the Minister. The more easily, too, because he has the able and continuing assistance of the Parliamentary Secretary, whose devotion to the Department and whose skill in discharging these functions are well known to me personally.

There are disadvantages as well as advantages in the office of Minister of Health, as with most things in this imperfect world. I dare say that I shall carry most former Ministers of Health with me when I summarise the main disadvantage of any Minister of Health, whoever he for the time being may be, as the Chancellor of the Exchequer, whoever he for the time being may be. There is a further disadvantage in that, owing to his lack of Cabinet status, unlike the Minister of Education, he pleads his case not among equals, but more as a suppliant. He is a sort of twentieth century edition of the Emperor Henry, at Canossa.

In spite of these disadvantages, and to compensate for them, there are many very real advantages. One in particular, which was a continuing joy and gratification to me, is the way in which it brings the Minister into contact with all those
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people, professional and lay, senior and junior, young and old, who are doing devoted and often wonderful work in the Health Service. In this category come the nurses, and that is the first reason for my intervention in this debate.

The second reason is perhaps a broader one. It is that the problem of nurses' pay illustrates and highlights a more general problem, one of the great unresolved problems of the present day, a problem which has its political implications, its social implications, its economic implications, and its ethical implications, too. This is the problem of how to devise, in the context of our economy, fair and just rewards for those people who are doing work which is socially valuable though not directly productive—work, in other words, which is not easily susceptible to precise evaluation by indices of productivity, but is no less precious simply because it is less precisely ponderable.

We have in the case of the nurses this paradox. It is an admired and well-loved calling which receives what to the instinctive feelings of most people are inadequate material rewards. I need not go into the figures of these things. They are well-known. A third-year student gets £336, or £206 net. A staff nurse starting at £525 gets £656 after six years. A ward sister or charge nurse starting at £656 goes up to £840 after seven years, the traditional period for which Jacob had to labour.

The figures are gross, except in the case of the student nurse, where the equivalent figure is £206 net.

The seeming inadequacy of these rewards—they certainly are not princely rewards, judged by the responsibility that goes with them—can, I think, be seen by two bases of comparison. The first is people also working in the hospitals but doing different sorts of work. The second is people doing similar work, but outside hospitals. The first of these bases of comparison includes ward orderlies and cleaners, with whom the right hon. Member for Middlesbrough, East (Mr. Bottomley) and the hon. Member for Orpington (Mr. Lubbock) have been concerned.

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The second is illustrated best by the example to which the hon. Member for St. Pancras, North (Mr. K. Robinson) referred, but did not particularise, which is adduced by the Royal College of Nursing. It says that a principal health visitor tutor employed by a local authority and paid on a nursing salary scale receives at the maximum more than £900 per annum less than the same person doing the same work in a college of technology and paid on the Burnham Committee scale.

There therefore appears to be a disequilibrium in nurses' pay. If that he so, it cannot be a matter for passive acquiescence—still less for complacency. We have to look to the causes and see whether we can suggest remedies. The causes are two. First, there is the historical cause, the fact that the particular evolution of the nursing service resulted in a position in which it was well behind in the economic sense when the State assumed responsibility in these matters. The second reason is that since the inception of the National Health Service it has not been found possible to do a sufficient revaluation to catch up the leeway then existing.

I shall say a word or two about both those matters. First, I deal with the historical evolution. Most people's knowledge of the history of nursing is probably more sentimental than factual. When nursing ceased to be the primary responsibility of the religious orders, there was a vacuum and by the early nineteenth century there was an unedifying combination of privilege and pauperism. The well-to-do in those days were not nursed in hospitals at all. We never read of the charming heroines of Jane Austen's novels going into hospitals to be nursed for those interesting illnesses which excited the sympathy of the hero and the reader alike. They were nursed under private arrangements at home.

At the other end of the scale, workhouse nursing was done by able-bodied paupers. In between there was another class. Nurses' pay at Guy's Hospital, where, presumably, they were well-paid, was £30 a year. At St. Thomas's, it was 9s. 7d. a week, plus beer. Of course, those rewards did not always get good nurses. As late as 1867 Florence Nightingale was writing that too many
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people came into nursing because they were too old, too weak, too dirty, too drunken, too stolid, or too bad to do anything else.

That was rather a harsh picture, because, of course, nursing attracted the highest as well as the lowest. It attracted the Florence Nightingales as well as the Sairey Gamps and the Betsey Prigs. Paradoxically, the effect was the same—the Betsey Prigs were paid very little because they were thought not to be worth very much, and the Florence Nightingales were paid very little because it was thought that they did not want very much. Nursing was a profession which was not to be sullied by sordid pecuniary considerations. It was by this conjunction of circumstances that nursing arrived at the inception of the National Health Service with leeway to make up. A third-year student nurse, in 1948, received emoluments of only £90 a year.

I come to the question of why the leeway has not been made up in the years of the Health Service. The short answer is that no basic revaluation has been undertaken because the period of the Health Service has coincided with a period of inflation. It is a truism that inflation bears hardly upon retired people living on fixed incomes, but it is no less true that it bears hardly on people paid out of public funds for this sort of work; and it bears particularly hardly on the people with leeway to make up because it will not be made up in a period of inflation.

I can show that in a very practical way. In the idiom of these matters there are two sorts of pay claim and pay award, the cost-of-living award and the revaluation award. The cost-of-living pay award, as its name implies, is merely concerned to make good the actual effect of inflation; in other words, to make good the depreciation in the purchasing value of the £. That does not cure any inherent defect, or make good any existing leeway. To do that we need a revaluation award. But in a period of inflation there has to be a succession of cost-of-living awards; and when there is a succession of cost-of-living awards the Government, naturally enough, shrink from further incursions into the public purse in order to make a revaluation award.

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In the 1950s there were five new increases in salary scales to nurses and a further 5 per cent. increase in the early 1960s. Those in the main were cost of living awards. I suppose that the one which came nearest to a revaluation award was the one referred to in The Times leader this morning, which took place during my time as Minister of Health. If my memory serves me, there was an increased training allowance for student nurses of about 7 per cent., for staff nurses of about 12½ per cent., and for ward sisters of about 20 per cent. That was a substantial increase coupled with differentials. It was a deliberate act of policy to concentrate inducements where they could exercise the greatest attraction on those who were minded to make, or were making, nursing their life career.

Would the right hon. and learned Member agree that although there was an element of regrading in that settlement, there were a number of anomalies which the staff side considered had not been dealt with, and which, I think the management side agreed, formed the substance of this regrading claim now before the Committee?

It was what is known as a package deal; but if one wants to get things done one often has to proceed on the basis of a package deal. These very substantial improvements were made. I do not say that it was a settlement for all time. It was a settlement which, even with the aid of the 88-hour fortnight—the principle of which was also introduced in those days—is not holding good today.

We are in a position today where we have to look at the facts as they are, and the fact is that time has overtaken that arrangement. I mention that arrangement in the context of the general distinction I draw between revaluation claims and cost of living claims.

I was very glad to hear my right hon. Friend make his statement this afternoon about a regrading exercise which is to
964
be embarked upon. I am sure that we all wish success to it. I should not want it to be thought that any piecemeal or short-term arrangement, however welcome it may immediately be, can take the place of the more basic revaluation for which I think the time has come, or is coming. Nor would I want it to be thought that we could look at these matters other than in the full economic context. Of course we cannot.

On the contrary, I do not suppose there was any speech I made in the country as Minister of Health in which I did not stress the dependence on a strong and sound economy not only of the National Health Service, but of the whole elaborate and admired structure of our social services which we call the Welfare State.

That does not diminish the desirability of a revaluation exercise; in fact, it reinforces it. We have to see what, as a nation, we can afford to spend on the social services. We have to ensure that we get the maximum value for what we can afford to spend and to ensure that within that amount we get the priorities and the relativities right. It is not a matter of looking at the National Health Service, certainly not the nursing service, in isolation. These problems are not solved in that isolated context. One has to look at a wider context, as we see from the relativities, from the unequal working of the Whitley machinery in various ways, and from the fact that there are other callings to which, at least to some extent, the considerations applying to nursing also apply. There comes to my mind, in this connection, those professions which received their professional status under the Act which I was privileged to introduce into the House, the physiotherapists, the occupational therapists, and so on.

I am not against an inquiry into the pay and conditions of nursing. I am not against an inquiry into the Whitley machinery. There is nothing sacrosanct about the existing working of the Whitley machinery; it is not old enough to be hallowed by time and not young enough to have been purpose-built for the needs of our modern Welfare State. My fear is not that we should be going too far by having such an inquiry, but that we should not be going far enough. Because of the considerations I have
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outlined, there is no single simple obvious solution to these matters. They are complex matters, with repercussions and ramifications spilling over into many fields. This is why I have suggested a Royal Commission to make an authoritative survey and examination of the financing of our social services in the context of our contemporary economic position and with the object of doing justice to all.

I made this suggestion initially about fifteen months ago, and I have reverted to it from time to time since. It has not yet found favour with the Government, the reason given being that it is concerned with policy, which is the preserve of Government.

I said that I would not give way to the right hon. Member for Clackmannan and East Stirlingshire (Mr. Woodburn). He would think me discourteous if I now obeyed what would be my natural desire and gave way to the hon. Gentleman.

I hope that the Committee will think that I would be, perhaps, the last Member to wish to trespass on the constitutional principles of Ministerial responsibility or the sovereignty of Parliament. But these principles would not be jeopardised by the suggestion I have made. The recommendations of a Royal Commission would not usurp the function of decision by the Government. They would help them to discharge it. Experience shows that in these complex matters it is a great help to the formulation of policy to have such an authoritative, objective and detailed survey. It was so in the case of Beveridge. It was so recently in the case of the Pilkington Commission into the Remuneration of Doctors and Dentists. There was policy involved in those matters, of course, but the Government made their policy with the assistance of those authoritative Reports.

There would be one valid reason why such a Royal Commission was unnecessary, that is to say, if there were a sufficient and clearly understood policy existing now. But is there? If there is, it is capable of definition. I am bound to say that I should not consider any tapestry of piecemeal adjustments to be a clear and sufficient policy, nor any
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reacting to events and pressures or even reference to arbitration if there were no principles against which the arbitrator could act. That is like asking a judge to decide a case without the benefit of either the statute or the common law. Of course, if all that is required is an automatic adjustment to the effects of inflation, then what is required is not so much an arbitrator as a statistician with a slide-rule.

If there is a policy, it can be clearly defined and effectively promulgated. If not, then I suggest that a Royal Commission would be a welcome asset to assist in the formulation of policy. If I am told that a Royal Commission would take a long time, I can only say that this is an important matter and, after all, it would have taken fifteen months less if it had been started when I first suggested it.

The great unresolved problem to which I have referred is a vastly important problem. How are we to secure for these people doing this socially valuable, but not directly productive work their fair share in the nation's economic growth? How are we to protect them from the erosions of inflation? How are we to secure for them revaluation when equity so demands? All these are matters which can emerge more clearly if an authoritative survey is made.

There are four basic principles which need not await the findings and enunciations of a Royal Commission. First, we have to see these matters in the full economic context. Good will is not enough. We have to see that we have the wherewithal to pay. Second, if the whole, or virtually the whole, of the nation's economic growth is to be claimed by, or reserved for, those who are engaged in direct production in industry, then there must be inequity for many of our fellow citizens, the so-called white-collar workers. Third, the strength of a pay claim must not be judged solely by its organised strength in collective bargaining irrespective of merit or the value of the work to the community. Fourth and last, but very important, no calling must be prejudiced because of a conscientious reluctance to invoke the weapon of strike or any other form of direct action.

I have sought to avoid sentiment in putting forward the analysis which I
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have made. Here we have a calling which, because of the high concept of its nature held by those serving in it and because of their sense of duty to their patients, eschews, and, in my view, properly eschews, the strike weapon and every manifestation of direct action. This must not count to their prejudice. In so far as their claims are good claims, they should be reinforced and not diminished in their appeal by the conscientious moderation with which they are advanced.

During the course of my three years at the Ministry, I had many opportunities of seeing the work and the quality of nurses in the teaching, general and mental hospitals and in the domiciliary service. Nursing is a calling which evokes and requires high qualities—industry and understanding, patience and self-discipline, and, above all, the great Christian quality of compassion, a constructive compassion which is not content merely to pity, but seeks to help and to heal, to comfort and to cure. With people like that, and a calling like that, pay can never be the sole or even the main consideration; but, just because this is so, a special duty rests upon us in the House of Commons to see that the rewards received are not out of tune with the qualities displayed.

The right hon. and learned Member for Hertfordshire, East (Sir D. Walker-Smith) has made a very powerful speech with which we on these benches can agree up to a point. Whenever one asks for or suggests a Royal Commission, the deepest suspicions are aroused because it is well known that one of the best stalling devices for a Government to adopt is to set up a Royal Commission.

The Government got out of their difficulties with the doctors in this way. However, I agree that, if we had a Royal Commission on nursing and if we gave nurses the same kind of interim treatment as was given to doctors, they might come out of it much better in the long run. But what is to be done in the meantime?

I am not quite sure where the right hon. and learned Gentleman stood on this and whether he now agrees with
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us that there should be an immediate and substantial increase because, whatever sympathy the right hon. and learned Gentleman and his hon. Friends may produce in this Committee, sympathy, as a trade union leader once said, makes no noise in the frying pan. That is what we are concerned with today. I am not quite certain that the Minister has gone any way at all to meet our request for an immediate and substantial increase for the nursing profession.

I want to declare my interest. I think that it is customary to do so. My wife was a nurse. Indeed, I think that the one thing that the Army did for me in the war was to put me in touch with my wife, so I declare my interest immediately. Therefore, pressure is on me from inside the family, but it goes further than my wife because my daughter, who is now 17, is about to enter into her training as a nurse. I am in this difficulty. She is very keen and enthusiastic. She has quite a good G.C.E. She is now applying for training in one of the training hospitals in London, and I am in the invidious position of saying to her, "If you go there you will be exploited. They will call you a Florence Nightingale. You will get any amount of sympathy but you will get about four quid a week."

I pointed out to her that in the Evening News, on Wednesday, 9th May, John Lewis was advertising for girls, not of 17, but of 15, at a wage of not less than £4 5s. at that age and not less than £7 5s. at the age of 18 plus profit-sharing, shopping discount, subsidised meals, a non-contributory pension scheme and social and sports facilities. I also pointed out that, at 18 on entry, she would get £259 a year net at 20—£4 a week for 44 hours, which works out at 1s. 10d. per hour. I said to my daughter, "If you go into the nursing profession the Minister of Health will come to the House and tell me that because recruits are coming forward that is a very good argument for not giving them any increase in pay." That is an argument he used in the previous debate and he has used it again today.

I want to refer to what the Secretary of State for Scotland said in the earlier debate. He said:
… common to my right hon. Friend and myself and to our hon. Friends is our intense admiration for the nursing and related professions.969
He went on, as the right hon. Gentleman did today, to deplore what they call an emotional attack on the Government for not giving material expression to their intense admiration.

What is the Government's case? the Secretary of State said:
It has been an emotional attack, because it has not got down to thinking of what the Government are doing. If we get into another inflationary spiral, the people who will sufler most are members of the professions, and nurses above all.
Why "nurses above all"? He went on to say that the nurses received a 15 per cent. increase in 1959 plus a further increase of 5 per cent. from 1st December, 1960, and that
… should be appreciated when all this emotion has been engendered today.
He also said:
The question is whether it would be in anybody's interest, above all the people themselves."—
he keeps repeating this—
if the claims were granted, …"—[OFFICIAL REPORT, 27th March, 1962; Vol. 656, c. 1214–6.]
He also said that pay was not the only element. A good deal of drudgery had been taken out of nursing. New buildings and an increasing number of school leavers should take care of recruitment.

The Secretary of State for Scotland produced five arguments for doing precisely nothing. First, that it was purely an emotional attack, not based on the facts. Secondly, that the claim of the nurses was a danger to the Government's pay policy. Thirdly, that other things are more important than pay, namely, fine new buildings, the removal of drudgery and so on. Fourthly, that recruitment was adequate and that the future of recruitment was assured. Fifthly, that in any case nurses got increases in 1959 and 1960.

I will take each of these in turn and comment on them. Concerning the argument about emotion, there is nothing wrong with emotion, more especially when it is based on fact. I quote to the right hon. Gentleman and to the Secretary of State for Scotland an extract from the Royal College of Nursing circular, which it sent to us some time ago. I am referring to the Scottish Board:
It is not an exaggeration to say that at no time in the history of the nursing profession in
970
this country has there been such widespread bitterness, dissatisfaction and despair felt by nurses at the treatment accorded to them in respect of their remuneration.
That is a fact—not emotion—not coming from a politically conscious trade union but from a profession that has eschewed, as the right hon. and learned Member for Hertfordshire, East said, strike action and any kind of political connection.

I went to a meeting at Kirkcaldy last Friday—an all-party meeting—with the hon. Member for Fife, East (Sir J. Gilmour). The nurses, before we went on to the platform, made it quite clear to us that it was a non-party meeting. I said that in that case they had no business to ask me to be there because I intended to make a party speech. That I did, and so did the matron, who was in the chair. I wished that the Minister had been there. His ears would have burned, if one can burn marble. I take the view that emotion in this matter is wanted. It is understandable and, indeed, it is inevitable.

As to the second argument on Government economic policy, the Secretary of State for Scotland said that nurses above all would be damaged by the inflationary spiral. The right hon. Gentleman the Minister of Health gave figures this afternoon showing that a 20 per cent. increase to the nurses would amount to about £19 million, which is, as I pointed out in a supplementary question, less than one-quarter of the increased concession that we are to make to Surtax payers this year. These are the priorities of the Government. I ask the right hon. Gentleman and any of his hon. Friends: do they regard the Surtax payers as of any greater importance than this body of workers—the nurses and the nursing profession? In Scotland the figure is that a 30 per cent. increase to the nurses would amount to £5.4 million, about one-eighth of the farming subsidy bill in Scotland, which is paid each year.

The Government White Paper on Incomes Policy refers—and the right hon. Gentleman referred to it also—to the need to relate income increases to productivity. This shows the cock-eyed and ill-thought-out nature of the Government's policy. How on earth do nurses increase their productivity? If a patient calls for one bed pan, does she
971
bring him two? If she is to administer a dose of castor oil, does she give a double dose? It is nonsense to suggest that nurses' pay must be related to productivity in terms of the Government's White Paper. We can apply this to all kinds of professions, to teachers and the like, and it seems to me to be quite absurd to attempt to relate this problem to the Government's incomes policy as enunciated in the White Paper.

The third argument that has been used by the Minister and by the Secretary of State for Scotland concerns the new buildings and the removal of drudgery. But the new buildings are long-term improvements. We cannot expect very spectacular results for many years. Meanwhile I would draw attention, particularly of the Under-Secretary of State for Scotland, to the situation in the West Fife area. I do not know how many times I have invited the Under-Secretary to have a look at the Northern Hospital in West Fife, where the conditions are absolutely scandalous and where there is no prospect of improvement for a long time.

It would be idle to pretend that, even assuming that we got the new hospitals tomorrow, we would get rid of more than a very small proportion of the drudgery which is inevitably attached to this profession. In my view, it has been romanticised far too much. If the Government were honest they would say, "This is a rotten job but a very important one, and because it is an unpleasant and vital job the nurses should be paid well."

That is a different argument. It is extremely gratifying, but that is no reason for exploiting the nurses. My argument is that precisely because it is a gratifying but extremely unpleasant job with little or no romance to it, they ought to have one of the very highest priorities when the Government are allocating the national wealth. This is my basic complaint against the Gov-
972
ernment, that here we have a Government responsible for making major decisions about the distribution of national wealth, and it is their policy which is causing people who do not normally take political action to begin to realise that the Government's priorities are all wrong.

This is not a circumstance that has developed overnight. It has been developing over the last several years. The hon. Lady the Parliamentary Secretary replied to my hon. Friend the Member for Oldham, West (Mr. Hale) not so very long ago when he referred to the low pay of nurses, and I remember her expression well when she rose to her feet and said, "Did I hear the hon. Gentleman aright? Does he suggest that they are badly paid?" That was her attitude and that was the attitude of the Government. They still believe that the nurses are adequately paid. At the moment they are saying that the nurses are not properly paid because the political pressures are on them in the country, but basically they believe no such thing.

I believe that the time has come when an enormous campaign ought to be mounted throughout the country amongst the trade unions in favour of a wage increase for these people in the short term; and in the long term, as the right hon. and learned Member for Hertfordshire, East said, a Royal Commission to establish priorities. I will bet anything that if there should be a Tory Government in power—which heaven forbid—when that Royal Commission announced its findings, the Government would not accept them.

This is the political aspect of the situation. The Government's priorities do not include adequate pay for nurses, teachers and public servants, but increases for the take-over bidders and the speculators. This is the difference between the two sides of the Committee. This is the difference which is being exposed today, and, despite what they say, the Government are finding that out.

In the last part of his remarks the hon. Member for Fife, West (Mr. W. Hamilton) pointed to one of the difficulties which
973
confront us today. While we all may agree that we should like to see the highest priority given to the profession which we are discussing today, I very much doubt whether we would find ourselves in agreement as to which profession should follow, in which order, that top priority. I must say that when we come a little closer to a reassessment of this position the difficulties which the hon. Gentleman outlined in the closing part of his speech will become more obvious than they are today.

Nobody will envy the position of my right hon. Friend the Minister of Health today. Frankly, I think that the position that he has had to hold since the nurses' pay claim was first made has been difficult and has become a great deal more difficult since Saturday. It is as well to be realistic and to face that fact. The Opposition have already related the settlement that was made on behalf of the dockers with the Government's pay pause policy and the position occupied by my right hon. Friend in relation to this debate.

My right hon. Friend reminded us that this is a debate about nurses' pay, and within that context he spoke. Yet it is quite obvious that to the outside world the events of Saturday and the debate today cannot be regarded as wholly unrelated, and I want to say a word about the situation, because I think that there is an important distinction to be made. If the Government declare a pay pause, which for certain reasons they regard as essential to the national economic health—a point of view which receives some acceptance in some quarters—then Ministers, at whatever cost in popularity to themselves, are compelled to uphold it so far as within them lies. In matters falling within their orbit, as nurses' pay falls within the orbit of my right hon. Friend, they must hold the line.

This is a new contribution to the romanticism of the age. One has always accepted that a general in the heat of battle cannot resign because there would be disastrous results from what would appear to be cowardice. No one has yet applied it to Ministers. Ministers are not compulsorily in office, and the remedy of a Minister who is faced with a duty which he regards as disagreeable necessarily is to resign. For the hon.
974
Member to say that Ministers should have medals for not resigning is a contribution to political theory which has never been enunciated before in this House.

The hon. Member, who is exceptionally well versed in these matters, understands the doctrine of Cabinet responsibility better than I do and I shall not argue with him now.

In other spheres of direct negotiation between the employers and the unions, which are not immediately in the Government's hands, some breaches are inevitable. They occurred before Saturday and they will occur again. They will occur even while this phase of the pay pause is on. The principle of the pause has survived them so far and will continue to survive them. It certainly could not survive surrender by a Minister of the Crown. I put it bluntly because it is important that this should be understood outside the Committee as well as in it.

Mr. Crichton can kick a hole in the policy without sinking it, but my right hon. Friend cannot. If he kicks a hole in this craft it founders. It is not altogether a question of who is the strongest, but of who is responsible and there is an important distinction to be drawn between the two. In this connection, I must admit that some confusion may have arisen in some people's minds about the proximity of my right hon. Friend in the closing stages of the dock negotiations just before the weekend. As I understand it, he acted in his Ministerial rôle and spoke on his own behalf as Minister of Labour. He spoke in that way, as Ministers of Labour have done before and, as speaking on behalf of the Ministry, he intervened in no way at all other than as a conciliator.

Since the hon. Member has spoken about the Minister's attitude and the acceptance of responsibility, may I relate his remarks to the actions of the Minister of Power on the question of electricity supply workers and their pay increase?

There is a very important distinction between the two. The position of the Minister of Labour must be clearly understood. Only three days ago the Opposition were accusing him of
975
attempting to influence a settlement, as it were, on behalf of the pay pause. There will now be some, no doubt, who will accuse him of attempting to influence a settlement against the pay pause. I suppose that that must be accepted as being within the traditional rôle of the Ministry of Labour.

There is a pattern—I will call it a shadowy line—which is now being made clear to us. This future pattern was alluded to by the Home Secretary in his speech last Thursday when he spoke about the probation officers. We look forward early next year to adjustments which will redress the balance of priorities between the professions and within them. In outline, this seems simple enough, but its fulfilment will be difficult unless we get a clear picture of the principles at stake.

I have some sympathy, without necessarily accepting, the solution offered by my right hon. and learned Friend the Member for Hertfordshire, East (Sir D. Walker-Smith) and the general course of action he outlined. However, I am sure that we would all have different ideas about which professions should enjoy the first priority and, within those professions, which sections should enjoy it. I find it difficult to see how my right hon. Friend or anyone else is going to apply this policy in the early part of next year unless a clearer principle exists.

I am left with the strongest impression that the wisest members of that profession desire a pay system which reflects and rewards nursing as a career. They are not deeply concerned by the knowledge that the hewers of wood and the drawers of water in some hospitals, particularly with overtime, may earn more than the skilled workers of their profession. In fact, many of them are more concerned on the hewers' and the drawers' behalf than they are on their own. I suppose that that sort of thing must be accepted in many skilled professions. In fact, the hewers of wood in many professions are themselves denied a career within the career structure.

The young nurse will, I think, balance what we call her "take-home money" with her prospects, and the lure is not only the lure of the lantern but also of the ladder. However much any career may be a vocation, everyone likes to
976
think that there are steps up which one may climb and summits towards which one may move. What matters is getting the ladder right, and that is why I very much welcome the assurance given by my right hon. Friend that the ladder is to be a matter of discussion and we look forward to a settlement between the two sides. I think that it will be accepted on both sides of the Committee that my right hon. Friend, since assuming office, has taken some steps to find out for himself, by travelling to the various hospitals and institutions in the National Health Service, just where these priorities may lie.

I have never accepted the view held by some hon. Gentlemen opposite that the wage pause operates with savage unfairness against the public professions—the public services, in particular. It is precisely in those professions that the standard of life is eroded by inflation. It is precisely those professions which are always last in the queue and, when we are in the sort of situation in which we are now and when the Government feel compelled to call for restraint, they find themselves left behind. When, under inflation, would we be able to give the nurses the standards we all desire for them?

With regard to the medical profession, that standard was given by a Labour Government in the initiation of the National Health Service when a new and completely high standard was initiated far the medical services. The hon. Gentleman will recall what, at that time, had been happening to doctors in country villages. Surely he will not dispute that. Is there any reason why that should not be done now on behalf of the nurses, or will Tory policy go on taking advantage of them?

The hon. Member knows only too well how far and fast we have moved in how many directions and how many changes in the structure of the profession have been made and how the priorities of the profession have altered in the fifteen years since the time about which he speaks. I am saying that there are factors in favour of the nurses' claim which militate against that profession in conditions of inflation. The exercise of restraint and the fact that they would never use the ultimate
977
weapon to enforce their own way are all things which penalise them in conditions of inflation.

The attitude of my right hon. Friend in particular and of the Government in general is widely regarded as a selfish and cowardly policy. On the contrary. To my way of thinking, it is quixotic to a degree, because to do that job properly requires him to hold the line at a point at which he is seen to have influence. To allow that line to reach a point at which he no longer has influence might provoke the maximum odium, both inside and outside this Committee.

The first and second phases of what is called the pay pause, though sound, have been insufficiently explained and not correctly understood and I earnestly hope that that error will be avoided in what we now refer to as phase three, the forecast of which in his own field my right hon. Friend gave today. What makes my right hon. Friend's position difficult today is not the harshness of the second phase, but the unfairness of the third, which lies ahead. Clarity on this third stage—the wages policy for the professions in relation to industry—is something on which clarity will become more and more essential; and it cannot be done by public opinion polls or even by discussing the matter here, because, I feel sure, none of us will agree about it.

A Royal Commission, which I always regard as the last refuge for those destitute of ideas, has been suggested. I dare say that such a Commission would give more guidance on this matter than we have seen hitherto. I gravely doubt whether, in a free society, this can be done merely by an appearance of equity, though equity may be achieved. Everything we are now discussing is subject to very strong tensions which exist today in various forms between what we are pleased to call wage and salary earners.

I need not elaborate on that, but it is true. It may be regarded as inevitable in a revolution of rising expectations. But the forces are there, and they are very strong. However much sympathy we may have for this or any other profession, they must be recognised if we are to meet those forces realistically. They do not make the next phase any easier, when I think that
978
Ministers will have less control than they like to think they have now. What they do control—it is very important that they should be made aware of this—is the place which they should occupy in the phase which lies ahead.

I am very far from advocating an abdication of responsibility. An element of responsibility by Ministers is recognised, and they will have to continue to accept it. But the further we as a Government tend to get involved in these arrangements and wage negotiations between the professions in general, the more intractable will the policy of getting the priorities right prove to be and the more unjust the results will appear. This is what puts my right hon. Friend in a difficulty today.

The more involved Ministers become in these matters, the weaker will the two negotiating sides become, because, when the Government are available to take a hand in matters, there is a tendency to put the baby in the Government's lap. I should like to see the two negotiating sides grow stronger and have an increasing, not decreasing, sense of responsibility. That is where the Government come in in a very important way. In an economic crisis, the Government always tend to get drawn into these matters and go beyond the point which some of us think they should go, as in this case.

I am very interested in what my hon. Friend is saying. Could he say how he views the difficulty which is arising of people who are under the control of the Government being held to the pay pause whereas the lead which the Government gave for a very good cause is being disregarded by those in the private sector? I should like to hear my hon. Friend's views on that point.

I sympathise with what my hon. Friend says. That is precisely the difficulty. When we are in a crisis such as that which we have been in since last July, the Government are left with no option but to exercise responsibility in these matters. As we move away from the crisis, I aim to see not merely the implementation of the increases which have been foreshadowed and a readjustment of the position, but the Government, mindful of their posi
979
tion, taking the opportunity to step back and leave the matter more with the negotiators and interfere less themselves.

Would the hon. Gentleman agree that an additional problem for the Government is that this question is mixed up with the campaign about the total cost of the National Health Service? I had the honour of introducing it in Scotland. The first thing to do was to establish a skill for nurses and a skill for doctors, because up to then theirs had been partly a charitable organisation. For the first time, it was established as a payment of-salary organisation.

One of the problems which we had to face was criticism about the increase in the cost of the Health Service, and a political campaign has continued ever since about the increase in the cost of the Health Service. But that increase has been almost entirely due to the fact that we began to pay the doctors and nurses decent wages. If we want to have our Health Service on the cheap, we can never do justice to the doctors and nurses. We must face the fact that there must be proper payment in the Health Service. Does the hon. Gentleman agree that that is one of the Government's problems?

The right hon. Gentleman is quite right. The Government's responsibility for the Health Service and for all the services connected with it and, to that extent, for what is paid to the members of it, cannot be escaped. But, as soon as the opportunity presents itself, the further the Government step back from the immediate day-to-day wage negotiations, the better. I believe that the more that they keep out of them the stronger and more responsible will the two negotiating sides become.

My aim is to reach a position in which wage negotiations, such as those for the nursing profession, can be freely conducted with a stronger sense of responsibility on both sides, with the Government being less and not more involved. Only in that way, whether we have a Royal Commission or not, will there be settlements which appear to be fair, unbiased and without political direction.

That is one of the things at stake in this policy in which I think hon. Mem-
980
bers on both sides know in their hearts the nurses have a strong interest. The pay pause is not directed at some remote economic aim far outside the sphere of ordinary men and women. If it succeeds in the way in which right hon. and hon. Members on this side hope it will, the pay pause will have as much to do with the future security of the nursing profession as of any other. If this policy succeeds, we may achieve that aim. If it fails, much will be lost. The responsibility for its success or failure rests heavily on the shoulders of my right hon. Friend the Minister of Health. If he falters, then this policy is gravely imperilled. That is why he carries my support and confidence.

As a result of my experience in working on various committees and of coming in contact with the medical and nursing professions, I know something of the work which they do. It is rare that I intervene in debates like this, but I felt that I should say a word or two about the nursing profession and pay my tribute to them for the work that they do.

It has been my unfortunate lot during the last nine months to be an inmate of three hospitals and a nursing home. It is very rare that one has that experience in such a compartively short time. Whether one is in a fee-paying nursing home or in an ordinary hospital, one finds the same loyalty, devotion, care and attention on the part of the nurses. For that reason, in my judgment, the nurses are entitled to a fair deal.

I tell the Minister, for whom I have a very high regard, that the nurses have not been valued correctly. We have heard a great deal today about their revaluation, but there has never been a real and true value put on them. They have always been at the back of the queue. As I stand in this Chamber and realise that we have to debate the pay and conditions of the nursing profession on the Floor of the House I feel a sense of shame. Their conditions and pay ought to be the very best that the Government can afford.

It is all very well for the right hon. Gentleman to say that we must cut their slice according to the national cake. How many times has that been done? It has
981
been said that we must have increased productivity before we can have increased wages. The nursing profession cannot increase its productivity; it cannot do any better than it is doing now. When I left hospital a few weeks ago I thought to myself, "What condition was I in when I went inside? What condition am I in now, after treatment by specialists and nurses?"

I shall never forget my thoughts then. I knew that the nurses were agitating for higher pay and better conditions, and I thought to myself, "If I had the power I would give them the Treasury". That is the feeling that comes over a patient who has been at death's door, and who has been attended to by the nursing and medical professions.

And here we are, quibbling about 2½ per cent. or 5 per cent. Here we are, making all sorts of suggestions to push these people further towards the end of the queue, and doing nothing but express our sympathy for them. As I have said before, there is a Lancashire saying, "Sympathy without relief is like mustard without beef". It is, it's very sharp. The sympathy manifested towards the nursing profession has been as sharp as mustard. The profession has been dealt with very sharply at the hands of the Government.

As an ex-miner, I understand the value of the nursing profession to the mining industry. On this subject, I speak with great feeling. I know what the position would be in our mining villages if hospitals had not been erected as long ago as in 1870, through the coppers of the mining movement, in order to get the miners attended to when they were injured. Yet, in 1962, we are denying the right of these people to be treated fairly. We are being unfair to the profession.

I hope that the Minister will bear in mind the speeches that have been made. We were all impressed by the speech made by the right hon. and learned Member for Hertfordshire, East (Sir D. Walker-Smith), who held the position of Minister of Health for three years. He has been on the inside in this matter. He knows what takes place. He knows all the arguments that are advanced, and the work that the nurses do.

Having been an in-patient in hospitals in three different towns recently I know the good work that nurses do, and the
982
sacrifices that they make. On many occasions I have said that to render help at any time is very desirable, but the rendering of help by a trained mind and a skilled hand is even more desirable. That is what we get from the nurses. We do not want to prolong the battle that is raging now on behalf of the nursing profession. It is difficult to prevent the miners from rendering practical support for the nurses, because they realise what the mining industry has received from the trained minds and skilled hands of those nurses.

It needs no words of mine to emphasise that this is a noble profession. To attain efficiency and skill nurses have to make sacrifices. They have to give devoted service, and show a great deal of courage. Right from their entry into the profession they have to be devoted to their duty. Let us not deny them now. Let us not prolong the agony.

Let us not keep talking about sending the matter to arbitration, or of having a revaluation; all the time we do that we are postponing the shouldering of our individual responsibilities in dealing with a section of the people who have given their best to our nation, and will continue to do so. Let it never be said that we have denied this profession fair conditions and a living wage. Such they are not getting at the moment. These people cannot withdraw their labour. It would be a sad thing if they did. In view of that fact let us not take unfair advantage of them. Let us give them what they want as quickly as possible.

The whole Committee welcomes back the hon. Member for Ince (Mr. T. Brown). We have all missed him during his absence, and we are glad that he is back among us in time to make his contribution towards this important debate.

I congratulate the hon. Member for St. Pancras, North (Mr. K. Robinson) upon his opening speech. There could not have been a better factual presentation of the case as we see it, and I support the views expressed by him. I am still very disturbed to know why my right hon. Friend found it impossible to set the inquiry in motion earlier, which is what the nursing profession itself was very desirous to obtain. I have always felt that in matters of this kind it is
983
much better to give before pressure has to be exercised. If there is a good case for this revaluation—as I believe there is—and for really examining the whole career structure, I cannot understand why my right hon. Friend found himself in any way inhibited because of the introduction of the pay pause.

It is very difficult for members of the public to differentiate between the two aspects of the dispute which has arisen over nurses salaries. Had my right hon. Friend found it possible, at the inception, to negotiate in the way in which he appears to be negotiating today, we might never have found ourselves in this very unfortunate and unhappy position.

I shall not keep the Committee for very long, because I have done a great deal of speaking in the last week or two. But in order to get it on the record I want to read a letter which I have received from the General Secretary of the Royal College of Nursing. I immediately rang up the Royal College when I saw what the hon. Member for St. Pancras, North mentioned as "kite flying" in one of the national newspapers, to the effect that my right hon. Friend had stated that he felt that the nurses would accept arbitration.

I have no idea whether the paper concerned was itself kite-flying. This is part of the problem of modern Parliamentary representation. It is very difficult in matters of this kind to find out the truth and to find out who believes in what and what section of the community is sponsoring what aspect of any matter. I find it practically impossible. I try to maintain a curious mind and whenever I read anything in the Press I try to follow it up to find out whether there is any foundation in fact to the statement made.

I well know, as hon. Members opposite know, that Governments fly a kite, sometimes very successfully and sometimes less successfully, but when I try to speak for a community with whom I have no real professional association I try to find out the facts. I therefore immediately got in touch with the Royal College of Nursing and asked before this debate had been announced whether the College would let me know its views in case pressure continued to come from my
984
right hon. Friend for the case to go to arbitration.

I recognise the award which was made by the Industrial Court in connection with hospital almoners and I agree with what was said by my hon. Friend the Member for Ashford (Mr. Deedes) that in all these discussions we have not had a clear lead or any clear explanation of what the third stage in this operation entails on the part of the Government. As I have already said in the House, I should have felt happier if "Neddy" had had on its Council representatives of white-collar workers and of the professions who could have talked about their problems as well as representatives of those who are connected with productive industry.

I should like to read the letter and its postscript, which speak for themselves, so that the Committee may know the views of the Royal College of Nursing. The letter is dated 10th May and is signed by Miss Hall, the General Secretary of the College. It reads:

§
I was sorry to be absent from the College yesterday when you telephoned regarding our attitude towards the possibility of going to arbitration on nurses' salaries.

§
The claim at present with the Management Side of the Nurses and Midwives Whitley Council has formulated not only with a view to rectifying the many anomalies which exist but also to bring nurses' salaries in line with those of other professions and to reflect both the value of service they give and the responsibility they carry. The College is not just asking for an overall increase in salary, but for the complete revaluation of the existing salary structure for all grades of nursing staffs within the purview of the Nurses and Midwives Whitley Council and at the moment we are not convinced that by referring the matter to arbitration this object will be achieved.

§
My Council is of the opinion that the next step should be immediate consideration on its merits of the Claim submitted to the Management Side on 11th August, 1961, and a resumption of unfettered negotiation on this basis."

§
Miss Hall signed that and added this postscript:
This letter was dictated on my behalf and was awaiting my signature when I returned to the College this morning. Whilst it faithfully sets out the College's view on this matter I think perhaps I should add that if the Government is adamant in refusing to allow the Management Side to negotiate the claim on its merits then, in our view, the only reasonable alternative is that an enquiry be set up immediately into the whole question of nurses' remuneration and that, additionally, the Management Side be authorised to enter into negotiation with the Staff Side to reach some interim
985
agreement, possibly on a percentage basis and certainly in excess of 2½ per cent. It is believed that these two things must go together as if an enquiry were set up it would probably be many months before its findings were complete and we would, therefore, regard it as essential that in the meantime the nurses received some improvement in their salaries as an interim measure.
This sets out clearly the exact wishes of the Royal College of Nursing.

§
As has already been pointed out, the financial side is a matter for the Treasury as well as for the Minister of Health. Therefore I should be grateful if, when he winds up the debate, my hon. Friend the Financial Secretary to the Treasury will make perfectly plain the attitude of the Treasury towards this letter. I have already let my hon. Friend have a copy, as well as my right hon. Friend the Minister of Health. I have thought, and I am glad that the Government have acceded to my view, that all this has been very unfair on the Minister. I also have had some experience of what goes on in parliamentary life. I sometimes feel very sorry for Ministers, though I do not think that I need feel sorry for my right hon. Friend. I feel sorry for Ministers who do not feel quite so strongly about the pay pause as my right hon. Friend does when they have to defend the case however hard they have been arguing with the Treasury and however much they have failed in the representations they have made.

§
I therefore thought it only fair that the financial side should be discussed and replied to by one of the Treasury Ministers and I should like to express my appreciation of the fact that my hon. Friend the Financial Secretary is to reply on behalf of the Chancellor of the Exchequer. The reply will be very interesting in view of the various speeches which have been made and which were so ably quoted by the hon. Member for St. Pancras, North. I am certain that the Minister of Science, for instance, did not feel as strongly about maintaining the pay pause for the nurses as adumbrated by my right hon. Friend the Minister of Health. It will be interesting to hear the Financial Secretary on this subject, having regard to what he said in his speech in the debate on the Budget.

§
It seems that my right hon. Friend the Minister of Health has been at least
986
persuaded that it would be a good thing to have an inquiry into the salary structure of the nursing profession. I am grateful that he has moved that far. I hope that he will also have an inquiry conducted into the position of the professions supplementary to medicine, which those professions also want.

§
If my right hon. Friend the Minister of Health was not quite so rigid in his views we should get on a great deal better in serving the interests of the nurses. I received a petition today from Tynemouth Infirmary where the nurses have collected 6,000 signatures from the general public in the small county borough of Tynemouth in support of their claim. It would be easier for all of us to get the spirit of the country and of the House of Commons put into action by the Cabinet if sometimes Ministers would consent to be guided. They are very busy people. They do not walk the streets as people like myself walk them.

§
It would be better if Ministers occasionally listened to people who are in contact with the public. I realise the heavy burden that rests on Ministers. I know that they do not have very much time to remain in contact with the public, but why do they not listen a little more to the professional associations which speak for their members, and to Members on both sides of the Committee who are pretty closely in contact with the problems that arise in their constituencies?

§
The Budget speech of my hon. Friend the Financial Secretary to the Treasury showed that he took a slightly less rigid view of the situation than that taken by my right hon. Friend the Minister of Health, and I was delighted when the Minister for Science got in with his colourful phrase about getting off the hook. I hope that, as a result of this debate and of the effect that has been created by the nursing profession, which has been at such pains to explain to all concerned what the nurses feel about their profession, we shall have a little further explanation of the offer made by my right hon. Friend. I wish that in opening the debate he had got down to basic facts a little more; that he had got down to the streets and the hospitals rather more than his rather cool calculated sentences indicated.

§
I am glad to have had the opportunity to read this letter from the Royal College of Nurses. I hope that the views of this important professional association will not go unnoticed by those—and this is really all of us—who wish not only to do justice to the nurses and midwives, but also to the country as a whole. When I refer to "justice", I do not always like to think that when we are arguing special cases we are talking just about the general question of salaries and wages. It is up to the House of Commons to see that justice is done, and I think that we should ask in advance of public opinion, rather than always wait for public opinion to stimulate parliamentary action.

§
I do not suppose that my right hon. Friend will be pleased with what I have said, but the words are from my heart. I think that we have got into a most difficult situation, and I do not want the nurses to think that Parliament does not understand their repeated requests for a complete examination of their salary structure and how they can best serve the interests of the country as a whole.

§
The young staff nurse who presented the petition to me said that she had never before really considered money, but now had apparently been told that her services were worth only 5s. an hour, and I thought how sad it was that this great profession had had to come down to expressing its views in this way, when the whole country wants to see justice done to it.

When the Minister replied to my hon. Friend the Member for St. Pancras, North (Mr. K. Robinson), he made great play of the unchallenged fact behind the pay pause, that increases must be related to increased production.

I listened with great interest to the right hon. and learned Member for Hertfordshire, East (Sir D. Walker-Smith), who I thought rather contradicted the Minister of Health, because he pointed out that we cannot talk about increasing the wages of lower-paid workers without first considering the fact that their wages are low, and there is no doubt that nurses' salaries were low before their claim was considered.

988
The statistics given by the Minister showed that the intake of nurses was greater, and that there were now more nurses than ever before, but I wonder from what source he obtained his figures. I hope that whoever replies to the debate will tell us how the statistics were obtained, because in my constituency the opposite is true, and perhaps I might tell the Committee about the position in the Brightside division of Sheffield.

When I entered the House twelve years ago, there were extensive lists of patients awaiting beds in the Sheffield hospitals. This situation had arisen because we needed new hospitals and more staff, and more people could afford treatment under the National Health Service. I am not blaming anybody for that state of affairs, but it was an unhappy situation which had arisen because of the neglect of our hospitals. At that time we had this difficulty of long waiting lists, and to deal with them extra beds were put into every ward in every hospital.

The situation today is different. In Sheffield, wards have been closed and there are empty beds in other wards. There are still long lists of patients awaiting admission to hospital, but it is not possible to admit them because of the lack of trained nurses to staff the hospitals in the area.

I wonder whether the Minister is prepared to admit that the situation varies from area to area, and that in Sheffield, at any rate, we are suffering from a shortage of trained nurses? It is this shortage which has given rise to the acute difficulties with which we are faced in the Sheffield hospitals. Wards have been closed simply because there are no nurses to staff them.

It is true that under the arrangements made by the Sheffield Regional Hospital Board there has been a large influx of nursing auxiliaries and ward orderlies, but there is a danger that the recruitment of these categories will dry up at any moment. If this happens, almost 50 per cent. of the wards in Sheffield will have to close because of the shortage of trained hospital staff. That is a very serious situation.

Why has this arisen? It is no use saying, as some have done in the debate, that this is the direct result of the small offer made by the management side of
989
the Whitley Council, an offer prompted by the Minister for a 2½ per cent. increase. What has caused the agitation among nurses and created the public response on behalf of them has not been the 2½ per cent. offer. It is the general conditions for nurses which for a long time have failed to meet the needs of the Service.

Of course, nurses are dedicated—the nursing profession is one of the most loyal sections serving the national health system—but they are beginning to wonder what this dedication means. This constant preaching about dedication, loyalty to their job and having no thought about their economic possibilities is becoming rather strange to their nature because they know that the orderly working in the same ward as themselves gets a higher wage than they do and is paid extra for his overtime. There are cases where ward orderlies in Sheffield hospitals go out after a week's work with almost the same remuneration as the matron.

I understand from my investigations that the Sheffield nurses have never been paid overtime. They are entitled to compare with the wages of ward orderlies who receive overtime pay the amount that they receive at the end of the week, from which deductions are often made because of the heavy expenses for them if they live in.

We do not need to restrict the comparison to ward orderlies. The nurses know what is being paid to some of their colleagues who have left the country. I have here an advertisement from the
990Globe and Overseas Mail of Canada asking for nurses trained in Britain. There is a shortage of nurses in Canada because of the development of the hospital services there. A nurse in Canada gets better amenities and conditions than exist in Britain, and her starting wage, according to this advertisement, is 4,500 dollars per year. This puts the remuneration of our nurses to shame.

The nurses also know what doctors and policemen earn, and they are also public servants. The doctors are well organised in the strongest trade union in this country. The nurses appreciate that that union over a long period has produced for the doctors as much remuneration as the doctors have requested—and they are dedicated people. Not long ago the drain from the police service was causing consternation. Because of the crime wave, the salary of the policemen was raised considerably—by £4 or £5 a week at one fell swoop. It was right to raise the wages of policemen and the salaries of doctors, but it is equally right to raise the remuneration of nurses. We must remember in that connection that just as we expect dedication on the part of the nurses, so they must be given justice.

Dedication is a fundamental belief to a good doctor, a good policeman or a good nurse. The Minister must not have too high a conception of dedication. If he retains the conception of dedication that he has had since he became Minister of Health, especially over the 2½ per cent. offered to the nurses, his name will not be one of the favourite ones recorded in our nursing records.

While dedication is indispensable to nursing, it will not save our hospitals from being unable to serve the general public as they were intended to serve them, because questions about nurses' remuneration will constantly crop up, and unless something is done speedily, the drain of nurses from our hospitals will be alarming and dangerous.

I draw the attention of the Minister to this matter of dedication because he bears a Christian name which means "dedication". In the Bible Enoch was the first of dedicated men, we are told. I think he was the father of Methuselah and the great-grandfather of Noah, and he walked with God. I want the Minis
991
ter to come down from the type of dedication which has been so glibly attached to his name—the dedication of extreme Toryism, the dedication that says that the pay pause is absolutely essential in every case despite what the conditions were before it was instituted. Let him come down from his Cloud-Cuckoo-Land, where he has been ever since he has been dealing with the nurses, and realise that for the nurses dedication means dedication to the service, and they demand dedication from the Minister who is in control of them.

I depart from the views of some of my colleagues in that, while I believe that the nurses were right to ask for public opinion to support them in their claim, I also believe that any section of the community which wants the public to support it in its claim for better wages and better conditions and for a complete overhaul of its remuneration should belong to the organisation which speaks for it in the negotiations.

The time has come for the nurses to organise themselves. They have to organise themselves as the doctors are organised. No dedicated Minister will then dare to say to them that, even though they put their value above an increase of 2½ per cent., they must still accept a 2½ per cent. increase. While I fully appreciate the services which the nurses give to the sick, the maimed, the halt, the blind and those others who need their services in hospital, the time has come when they have to have justice side by side with dedication. They have to organise. The right hon. and learned Member for Hertfordshire, East defended the right of nurses to strike despite their dedication. They must be strong because the day for a strike will come unless there is a much better response to the call of the nurses than we have yet had.

The big condemnation of the Government over the last twelve months of their pay pause has been that they have killed Whitleyism for public employees. They have to do something to restore confidence in Whitleyism which has been almost set aside. They will have to do something more than have an inquiry to decide what the wages of nurses should be. They will have to have the sort of machinery with which the Government cannot interfere too closely,
992
too often, or too effectively. The negotiations within the machine should be binding upon all parties. If the nurses can be given sufficient organisation, they will be able to obtain their rightful constitutional position not only with dedication, but with remuneration.

I am one of those hundred or so hon. Members on this side of the Committee to whom my right hon. Friend the Minister of Health referred as having signed the Motion in the name of my hon. Friend the Member for Maidstone (Mr. J. Wells) urging the Government to set up a review of the salary structure of the nursing profession. I know that many hon. Members on this side of the Committee share my view that we very much welcome my right hon. Friend's statement that there would be a letter from the management side to the staff side urging contact and a review and revision of the nurses wages structure. That is one of the most helpful and constructive pieces of news which we have heard for a long time, and I should like my right hon. Friend to know that he has a great deal of support for letting us know that that initiative will be taken.

I respect the knowledge of the hon. Member for Sheffield, Brightside (Mr. Winterbottom) about trade union negotiations and from that his view on Whitleyism and so on. I do not have that first-hand experience, as he must know, but I am as interested as he or any other hon. Member in getting a fair deal for all workers, whether they are white collared or manual. We are dealing with nursing, a public service, which became even more of a public service when it was nationalised, when the National Health Service was set up and when the Government were brought more directly into the arena, so to speak, in a way which was welcomed by hon. Members opposite and subsequently supported by my own party, so that the burden of improved wages or conditions is borne by the Exchequer. Is it not only right that at some stage in the proceedings the Minister of the Crown responsible for that service should have a say about what can or cannot be afforded?

993
We had the same old argument when my right hon. Friend the Minister of Education became involved in an argument about the Burnham scales. I had to listen to teachers saying that he was exercising a monstrous control over the freedom of negotiation enjoyed by the teaching profession. The same sort of charge has been made ad nauseam this afternoon and on other occasions in the past few months about the nursing profession.

When the burden has to be borne by the public and the public is represented by the Minister responsible, if at some time he feels that the negotiations are not being carried on in the public interest, or that too big a strain is being put on the Exchequer, or that the negotiations are contrary to Government policy and so not in the national interest as conceived by the Government, then the Minister must take a strong line. I do not see any way out of that. The situation has been exacerbated through the nationalisation of medicine in which hon. Members opposite took such a great part in 1948, twelve or thirteen years ago.

I do not want to resurrect the question of whether we should have nationalised or socialised medicine in this country. The decision has been taken and although there are flaws in our National Health Service which will have to be put right, there is no question of its being unscrambled. With many other hon. Members, I am only too willing to defend its fine achievements, and I have done so in the United States and in this country. But I, like other hon. Members, want it to be regarded as a service which can be improved and with conditions for those who work in it which can also be improved. I suggest that the hon. Member for Brightside and others are simply begging the question or, to put it more crudely, passing the buck to my right hon. Friend when they show him to the nation as some sort of Jekyll and Hyde personality.

The hon. Member for Holborn and St. Pancras, South (Mr. Johnson Smith) has forgotten that the Government are already represented on these wage-negotiating bodies and have an opportunity of briefing those who represent them. They cannot have it
994
both ways—they cannot negotiate and make the final decision. That way lies dictatorship.

The hon. Member says that it is dictatorship. The Government have been elected and are responsible for the paying of wages in what is virtually a nationalised concern. In the final analysis, the elected Minister of the Crown must have the say if he feels that negotiations are going contrary to the public interest as he and the Cabinet conceive it. The hon. Member is entitled to call that dictatorship if he wants, but I do not regard it as dictatorship. I appreciate that the Government have representatives on these bodies, but it came to a crunch when there was a possibility that the negotiations would result in wage increases beyond the 2½ per cent. figure. As a supporter of the wage pause, it seems to me only right that the Minister should say that the Government could not at this stage of the game contemplate increases above 2½ per cent. There is no Government representation on the Burnham Committee, which is why that system needs overhauling.

The hon. Gentleman should draw the right comparison. When dedication is equally involved, as with the nurses and the doctors, how can the Government decide to give the doctors an increase while they restrict the nurses? If there is to be justice, it must not only be justice but be made apparent.

The hon. Gentleman will not share my optimism that in the long run the nurses will get as square a deal as other members of the medical profession have had from the Government in the past.

There is a well planned and organised campaign directed to show my right hon. Friend as a sort of Jekyll and Hyde personality. He is a Jekyll when he produces an imaginative and far-reaching hospital modernisation and building programme. Everyone congratulates him then, but I wonder how many friends he will have when we have to look for the money to pay for that plan. He is a Hyde when he endorses and supports the Government's wages policy on nurses' salaries. He becomes a Jekyll again, as anyone who knows any-
995
thing about the medical profession knows, when he gives his devoted and intelligent attention to the development of services for the mentally sick services, which, in the eyes of many people who know about the National Health Service, have reached a point when they should be expanded. But he becomes a Hyde again when he annouces that he intends to increase charges, an announcement which came at the time when he was regarded as a Jekyll because of his hospital plan.

This happens with the Prime Minister himself. All the newspapers said, "Mac does it again" when he saved us from a railway strike, but a few weeks later, when we were called upon to bear the cost, all those who had muttered pious phrases about how wicked it would have been to have a strike over railway wages when the railwaymen received such pitifully low wages were the first to turn round and run down the Government. Now we have the same sort of thing with the nurses.

My hon. Friend the Member for Bradford, West (Mr. Tiley) is not here this afternoon. Unfortunately, he has other duties which take him in the direction of Strasbourg; but I have some notes which he made after meeting sisters and nurses at the Bradford Royal Infirmary. On this question of the sympathy which comes from hon. Members opposite, I note that in one paragraph he says that the nurses and sisters to whom he spoke were all annoyed at the way in which since 1951 the Government and the Minister of Labour had constantly given way to wage demands from the larger industrial units.

I am constrained to feel that that is an unjust charge to level at the Government, because there is a large sector of industry where both management and trade unions are perfectly capable of so running their affairs that it is possible for large wage increases to be given. There are some of us—there are economists on both sides of the Committee and objective people outside the House of Commons—who consider that that is one reason why we have had such a rate of galloping inflation, and one of the reasons why nursing, with many other professions like it, has been put behind in what my right hon. Friend called the rat race of wage inflation.

996
I find it particularly nauseating, sick-making and hypocritical when such people involved in such unions now engage in token strikes in support of the nurses. The hon. Member for St. Pancras, North (Mr. K. Robinson) reminded us of what seemed to me to be an isolated instance. I had certainly not read of others in the Press. It was of people who took another course of action on which both management and labour are to be congratulated; they gave a donation to the Royal College of Nursing. But that was not the pattern throughout the country; it was an isolated instance. I find it sickening and nauseating that some groups who have been contributing so much to the decline in the nurses' financial position through inflation should have been almost the first in the past few weeks to say to nurses, "We will come to your help", and the way in which they chose to do it, after years of contributing to inflation, was to strike or to stop work an hour early. The hon. Member for Birmingham, Small Health (Mr. Denis Howell) laughs. I think that that was a reasonable comment to make. If he can do anything other than laugh he should get to his feet and make such useful contribution as he can.

All this has made the position surrounding the nurses' pay problem so emotional. With respect, I think that some of the suggestions made by hon. Members opposite this afternoon have not been particularly constructive, and in my remaining few minutes I will try to suggest that there is a constructive course which can be taken now that we have heard the news of the possibility that the whole wage structure of nurses will be reviewed. It seems to me, from views which I have heard expressed, that there is no real dissatisfaction with the present scale for trainee nurses and for most matrons. I understand that the main bone of contention is that the structure is wrong on two grounds—first, that the scales in many respects are indequate and, secondly, that the structure is unfair between one group and another. The obvious comparison which strikes most people as unfair is that the salaries of certain grades in the nursing profession compare very unfavourably with the money which can be earned by people in comparable jobs outside the profession. The example which has
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been quoted this afternoon is that a nursing sister can expect a maximum of £840 a year whereas a school teacher can expect a maximum on the basic scale of about £1,100 a year. Some people feel that on grounds of comparability alone this is unfair. There is a further criticism which this review, if it is to take place, might well consider, and it is that the reward is not enough for those who work in the nursing profession for a great many years.

In both these respects the nursing profession is joined by the professions supplementary to medicine, who, it seems to me, come to a dead end financially after six or seven years of service Quite apart from the arguments over the level of what many people might feel to be an inadequate scale, in the professions supplementary to medicine there seems to be scant recognition for additional qualifications and for the additional responsibilities accepted by those who wish to teach, always assuming that a post is available. I have heard much criticism on that score from members of the professions supplementary to medicine.

Many to whom I have spoken also feel that in other respects the salary structure defies logic and lacks fairness. Perhaps this is because the wage structure was not planned in the first place; as one senior member of the nursing profession said to me, "It was not planned, it just grow'd like Topsy". Anyone who examines it closely must believe that to be the case. For example, there seems to be a wide difference in the salaries of comparable grades in different fields of nursing.

This makes me feel that it would not be easy to introduce a greater sense of equity into the salary structure, because, apart from the increase in costs which would fall on the Exchequer from any change in salary gradings, I know that opinions are divided in some instances and on some issues even in the nursing profession. For instance, it is said that midwives and nurses trained in the care of mentally ill have always thought that they should be on a higher scale than comparable grades in other parts of the nursing profession. They may be right to hold this view, but I am not in a position to judge to what extent their position should be adjusted in the light
998
of the medical changes which have taken place in other parts of the profession.

It seems to me that this is essentially a problem for the experts, but I cannot help noticing that it is these issues which have done a great deal to exacerbate feeling and to cause irritation. Time and again I have found people trying to draw me into some expression of opinion, just as last year teachers were trying to get me involved in discussions over their differentials. As I see it, this is not a job for Parliamentarians but a job for the experts, and I hope that they will be able to overcome these divisions of opinion, because they must do so if the nursing profession is to preserve the reputation and respect which it enjoys in the community. If they do not, and if we find that while there is discontent there is also some internecine rivalry, slowly and surely the nursing profession will lose the high respect which it has enjoyed, just as this sort of rumpus and discussion between one group of teachers and another, which we saw exploited so coldly and brutally on television, did a great deal to undermine the respect which some members of the public have for the teaching profession.

The hon. Member is putting up and knocking down Aunt Sallies which no one else has put up. No one is arguing whether one grade should be superior to another in these claims. The simple question is whether the nurses should have the right to negotiate with their employers, which the Ministry prevented them from doing. Will the hon. Gentleman tell us simply whether he thinks that the Ministry is right or wrong?

I trust that the hon. Member was trying to be helpful, but I understand that when they put forward their original wage claim the nurses also wanted the whole structure to be reviewed. My right hon. Friend has agreed that a letter will be written by the management side to reopen negotiations on this point. I think that this is a valuable and very useful step forward. I was pointing out some of the irritants to the nursing profession—for example, that it seems to be a very poor wage structure and a very poor differential system and the fact that there is a feeling that it is not as fair as it might be. It seems to me that this is not a
999
lot of window dressing—this idea of negotiating a new wage structure—because there seem to be some very complicated points with which both sides have to deal. I think that it is quite fair to draw attention to them.

We must not forget that a few years ago there was some sort of review of the wages structure of the nursing profession—a structure which gives so much cause for discontent today. It seems to me that this fact only underlines the need for another review and the difficulties of getting the right solution. I am told—and my information I think was fully endorsed by my right hon. and learned Friend the Member for Hertfordshire, East (Sir D. Walker-Smith) this afternoon—that when those in the nursing profession were told that they had had a review of their pay structure some two or three years ago, they were told that it was not nearly far-reaching enough and that it was accepted only because it was part of a package deal which included, among other things, pay rises up to 25 per cent. They argue that if they had had a real say in the review it would have been more far-reaching, and this gives another reason that another review is needed, in spite of the fact that we had one three or four years ago.

While I am on this subject, it seems to me that quite a number of points have not had as big an airing as they might have had in some of the superficial articles which I have read in some of the newspapers. There are some minor irritants as well as financial irritants—for example, the question of laundry charges. It is pointed out that a person who joins the Army is provided with a uniform and, as far as I know, he has not to pay cleaning charges, certainly for that part of the uniform which he has to wear in pursuit of his duties. Although it is a nominal charge, a nurse has to pay £5 per annum for her uniform, and more and more of us are finding it difficult to understand why she should also have this irritating charge imposed on her when she has such a low salary scale and, in addition, must make a contribution to the cost of keeping it clean when she wears the uniform solely in the performance of her duties.

1000
Another irritant to which I draw attention is that, as I understand it, the emoluments are often considered to be very unfairly charged and in some cases not worth the money which is deducted from the salary. An example of this is that of a matron of a maternity hospital who lives on the premises and who has two rooms; above them is the labour ward and below them is the nursery. As I have a small baby I appreciate some of the disturbances which she must experience on a much larger scale. Yet she is expected to pay the same board and lodging charge as is another matron who enjoys fax better amenities. If the review of the salary structure took this sort of thing into account it could remove an important irritant.

I want to end on a philosophical note which I do not think has sufficiently emerged in the debate. I do not pretend that it is an original note. The problem which has emerged from the debate, perhaps from my own words and certainly throughout the country, is invariably concentrated on money. People have compared the wages of the nursing profession with those of other members of the community who are far less skilled and whose value to the community is often considered to be far less. I have made the comparison in my speech. It seems to me that this has led some people to advocate wage increases for the nursing profession which are quite unrealistic. I have suggested that if there are bigger wages, the increases must be more selective. Some of these unrealistic wage increases which have been suggested seem surprisingly generous. In view of what has happened in the past, I wonder how willing people will be to find the money when the time comes to meet the bill.

Although I fully recognise that pay is a very important part of this story, it is only a part of it. Although an important part, it is only one of the many rewards which a nurse can get for doing a job, because her job is a calling. Those who undertake it find that it is an all-absorbing part of their lives. They find in that calling a satisfaction and reward which in my view can never be measured in £ s. d.

When people compare the job which a nurse does with that done by a cleaner in the wards or a shorthand typist, or
1001
with other workers, it seems to me that they forget one very important factor—that people who do some jobs in our society do not find in them the satisfaction which is found in some callings. There is not the satisfaction to be found in many of the tedious jobs which have to be done. The main reward to be gained from some jobs is the money. The money is the overriding, if not the sole, satisfaction to be derived from doing some jobs. To compare the job done by nurses with such jobs is unfair to the nurses and unfair to those who do jobs where money is the sole reward because there is very little else from which to gain satisfaction.

Although I hope that the upshot of this dispute will be a fairer and, in certain respects, a more generous wage structure, I am conscious that to concentrate on obtaining higher and higher remuneration for the nursing profession is not the only way to obtain a bigger and happier nursing service. That is another story, which no one knows better than the nursing profession, which at the moment by its dignified bearing has convinced me, at any rate, that it appreciates the complexity of this problem.

The hon. Member for Holborn and St. Pancras, South (Mr. G. Johnson Smith) seemed to get himself into a rage about what he called the nauseating sympathy which the nurses were getting. I know that he was speaking about only a section of the community. I shall refer to that later. If he regards support for the nursing profession in their present dispute with the Minister as nauseating, or if the people who support the nurses nauseate him, he is castigating the majority of his fellow men and women.

The hon. Member for Tynemouth (Dame Irene Ward) was good enough to say that my hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) made a very good speech. Perhaps I, as a back bencher, may be allowed to say a few more critical words about the Minister's speech. I have had the pleasure of hearing the right hon. Gentleman speak on many occasions in this Chamber, both as a back bencher and as a Minister. I have more often
1002
than not disagreed with him, but I have nearly always respected the way in which he put his point of view and the stimulating manner in which he delivered his address.

I have never heard the Minister less convincing than he was this afternoon. To take only one example, throughout his speech ran the assumption that the staffing position in hospitals was in a good state. As the hon. Member for Tynemouth said, why does not the Minister get around and find out? If he really means what he says, and bearing in mind what he said at the weekend about the inaccuracy of ministerial statistics, he is very badly informed.

We can all relate either constituency or personal examples. As it happens, recently I have been attending one of the great London teaching hospitals as an out-patient. I have no complaints about the way I am being treated, but I will tell the Minister of my experience. I present myself to the records section of the out-patients' department. The person I see there is an African. I have been dressed, and have attended on other occasions for my dressings, by Pakistanis, Indians and other nurses from overseas. This is in a great London teaching hospital. I have no complaints. They have been absolutely charming and first class.

I go round the hospital. The other day I asked a man who I assumed to be a porter how to get to a certain place. I admit that in a hospital a consultant can easily be mistaken for a porter because of the white coats they wear. I asked this man the way. He did not speak English. At least, he did not understand my accent. He did not understand the English language as I speak it. He found another man to direct me. The second man turned out to be a Cypriot. This is the position in a great London teaching hospital where, as far as I can judge, they are doing magnificent work in a physical environment of the utmost squalor.

The hon. Member for Holborn and St. Pancras, South spoke of the Jekyll and Hyde character of the Minister. I hope that the much vaunted hospital building programme will be a reality and not just something on paper. In my part of the country, as in other parts, paper plans for new hospitals
1003
were announced with great flourish a year ago. So far, not a brick has been laid. I hope that the Minister will do better. There is certainly plenty of room for it.

I do not accept that the staffing position is as good as the Minister suggested. I have had conversations with nurses at the London teaching hospital to which I have referred. Some have told me that they are not staying in the service. One told me that, despite the nature of her work, she was taking L.C.C. classes in shorthand and typing. She has almost reached a degree of proficiency which will enable her to escape from the hospital.

I said to her, "Do you not like nursing?" She said, "Of course I do. I like it very much, but I am 31 and I cannot earn enough at it. I am going to get out of the profession into a clerical job". But it will not be in the public service. It will be in the private sector where I have no doubt she will get a more handsome reward. This is going on all the time. This is the type of experience all hon. Members could have had if, in recent weeks, they had been attending a hospital as I have been.

I want now to say something about the case as it is put to me by my constituents. Like the hon. Member for Holborn and St. Pancras, South, I have within the confines of my constituency one of the great nurses teaching hospitals, the Manchester Royal Infirmary. I have had the pleasure of discussing this problem with a truly representative body—a sister tutor, a ward sister in charge of an acute ward, pupil midwives and general nurses. I will not seek to give chapter and verse to the Committee as it has been put to me. As hon. Members have said, the whole wage structure is shot through with glaring and indefensible anomalies. There is the absurdity, for example, of the qualified S.R.N. who goes to do pupil midwifery and whose increments come to a full stop for a year.

As my hon. Friend the Member for St. Pancras, North said, nursing is a much more highly technical business than it was even a few years ago. Girls in charge of acute wards reach the maximum, if they qualify at the earliest
1004
date, at the age of 30. If matrimony or other causes have not carried them off, they face the prospect of no further increments until they reach retiring age at 55.

These anomalies in the wage structure should be examined. I will not say more to the Committee on this because, if we do not know of these anomalies from our personal knowledge, in the last few weeks and months the General Nursing Council, the Confederation of Health Service Employees and all the professional organisations have made all Members of Parliament acutely aware of the situation.

The hon. Member for Holborn and St. Pancras, South has been very critical about some trade unionists who have recently taken industrial action in support of the nurses' wage claim. I dare say that most people would agree that it was perhaps not the wisest and best thing to do, but I found the word "nauseating" as used by the hon. Member a little hard.

Hon. Members opposite and their supporters in the country in the years since I have been an hon. Member, since the war, in public and private have castigated the industrial worker for selfishness and for seeking personal interest by staging unofficial strikes or contemplating official strikes and—as hon. Members opposite would say—holding the country to ransom. However deplorable they may say that industrial action may be, no one can say that this action was selfish. It involved loss of earnings because they were demonstrating their support for the nurses.

This action has been condemned by the nurses and by some trade union leaders but it should not be termed "nauseating". If any of my hon. Friends have any doubts about industrial action for what one might call altruistic reasons, they should not forget how our late friend Ernest Bevin boasted about the action of the dockers in support of the Russian revolution in its early days and how they demanded "No arms for the Jolly George". So there are respectable precedents for this kind of thing.

As I understood the remarks of my hon. Friend the Member for Holborn and
1005
St. Pancras, South (Mr. G. Johnson Smith) the hypocrisy of the trade unions was not in the token strikes, and so on—which are relatively small matters—but in the demands of powerful unions for more and more wages which had created an inflationary cycle in which those same powerful unions were saying that it was not their fault, although, in fact, the whole thing was their fault.

That was not at all what I understood the hon. Member for Holborn and St. Pancras, South to say. He is well able to look after himself. If I have misunderstood he will, no doubt, interrupt and I shall give way to him. I understood him to say that he was nauseated by the stoppages which had taken place. Is that right?

My hon. Friend the Member for Maidstone (Mr. J. Wells) gave a more accurate interpretation of what I intended. If I also gave the impression to the hon. Member for Manchester, Exchange (Mr. W. Griffiths) that I also found the token stoppages, which were condemned by prominent trade union leaders, nauseating in their own right apart from the other aspect, that would be a correct interpretation. So between the two hon. Members I think that they have got it right.

We have cleared up any possibility of misunderstanding. I have said what I think about the action of the workers concerned and the position of the hon. Member for Holborn and St. Pancras, South is now quite clear.

I now say a word about something which was referred to by the right hon. and learned Member for Hertfordshire, East (Sir D. Walker Smith) and by my hon. Friend the Member for Fife, West (Mr. W. Hamilton). They spoke of what one might call the global conception of what we can spend on the public services today. The condemnation of the Government is that we cannot regard the situation of the nurses in isolation from the general decay and rundown in the public services as a whole. This has been achieved by the Government, who have had responsibility for the affairs of the country for the past eleven years.

It is not merely the condition of the nurses. Under the Government all the Health Service workers have had their
1006
status and their pay relative to those in private industry depreciated. They have suffered a decline in status and in pay which is shared by public officials, by the Civil Service, by postmen, by firemen and teachers. All those people in the public service have been discontented and in revolt about wages and conditions in the past eighteen months or two years.

It is the condemnation of the Government's policy that they are unable to meet a perfectly reasonable wage demand by people such as nurses about which we can all get easily emotional, yet at the same time find nothing unhealthy in a society which had 600 successful takeover bids last year. As a member of the Labour Party and a Socialist I say that the public services can be buttressed, expanded and refurbished in the way in which Socialists want only to the extent that private wealth is collected more by the Government.

I challenge any hon. Member on either side of the Committee to tell me if a square deal can be given for the public service within the context of current economic policies. In my submission, it cannot be done. It is an unhealthy state of affairs in which we can have this rundown of the public service, which everyone must admit, and, at the same time, a society which sees nothing wrong in someone like Charles Clore making a personal fortune of £30 million during the last few years. These things do not go together.

I want to see an improvement in the public services and I want to see something done immediately for the nurses, but at the end of the day, from different points of view, the right hon. and learned Member for Hertfordshire, East and my hon. Friend the Member for Fife, West have to face this. Any Government have to say, "Inside the national economy how much can we afford for the public services and the social services?" On that issue on many occasions in the months and days ahead Socialists and non-Socialists will argue the case in the House of Commons.

I am sure that the hon. Member for Manchester, Exchange (Mr. W. Griffiths) will understand if I do not follow him in his remarks, although I agreed with
1007
that part of his speech, as with that part in every speech which has been spoken from the heart and paid tribute to the nurses. I got completely bogged down in the hon. Member's remarks about the philosophy of the Labour Party, but perhaps he can explain that to me at some more convenient moment.

I thought that my hon. Friend the Member for Ilford, South (Mr. Cooper) was a litttle inaccurate when he referred to nurses always having been paid overtime. I think that I am right in saying that that applied only to a small number of nurses engaged in mental hospitals. There are four hospitals in my constituency and I have had considerable correspondence about the subject we are discussing tonight.

As this debate is beginning to get a little "stuffy", perhaps I may be excused if I relieve the atmosphere slightly by reading a little ditty I had from some nurses in Chichester. They wrote to me as follows:
Even M.P.s do not knowWhen it is their turn to go.When you badly need a nurseYou may remember this small verse.We've struggled on in wards short staffedWe've worked long hours and only laughed.We've stayed on late to give a handWhile others played throughout the land.We've given up our hours of leisureTo run with bedpans, weigh and measure.We've never grumbled much about moneyBut we cannot live on bread and honey.But please, sir, we cannot pay a rising rentOn a miserable two and a half per cent.So raise your voice in the House tonightFor those who cannot work to rule or go on strike.
The communication was signed:
Yours in haste, from poverty-stricken nurses.
I suppose that that must be considered as an anonymous communication. I cannot acknowledge the author; I wish I could. It is the only anonymous communication I have received which did not go immediately into the wastepaper basket.

The last line, about
cannot work to rule or go on strike
is very true.
1008
When we had a debate recently there was some disagreement about whether nurses could or would go on strike. I remember my hon. Friend the Member for Harborough (Mr. Farr) saying that he was quite certain that they would not, and the hon. Lady the Member for Blackburn (Mrs. Castle), seemed to have some doubt about that. I do not seek to criticise the hon. Lady, because she is not present, but I think that even she, in her militant mood, which we so often admire, would, if she were a nurse, never go on strike or leave a ward of invalids to fend for themselves. However, even though they may not be able to go on strike, nurses have the priceless asset of the sympathy of everyone in the country.

We should not completely ignore what has been done for the nurses by the present Government. One of my difficulties in the House is that I try to look at both sides of any question, and to questions of this sort there always seem to be about twenty-four sides. I always admire hon. Members who are barristers and who manage to stick to their brief and slam home the point they wish to make, taking little notice of the opposition. Perhaps they have taken a great deal of notice of opposing arguments in the past and have studied all sides of the matter, but they still manage to appear to ignore the other side of the story. I envy them for this, although I sometimes suspect that they may spend some rather sleepless nights.

One cannot, in fairness, completely ignore the benefits which have accrued to the nursing profession. I do not pretend that nurses are anything like sufficiently well paid, or that their case has the right priority at present, but I feel that one should mention that they have had six increases of salary since 1951. In real terms, taking into account board and lodging as well as a rise in the cost of living since 1951, student nurses have received an increase of about 35 per cent., women staff have received about 40 per cent., ward nurses about 45 per cent. and matrons, varying according to the size of the hospital, about 12 per cent. to 15 per cent.

Indeed, one can say that nurses have to some extent been contracted out of the rise in the cost of living, which is more than one can say for pensioners
1009
and people living on small fixed incomes. Moreover, there has been a great improvement in the conditions of service, in nurses' homes, and so forth, to say nothing of the plans for the future which have been much mentioned already.

In addition, there is the excellent work done by many hospital management committees. Last Friday, I was delighted, when I called on the very highly respected matron of the Royal West Sussex and St. Richards Hospitals, in Chichester, that she specifically paid tribute to the work done by the hospital management committee in that area.

To return to the matter of salary increases, the point is that, however much nurses' salaries have gone up, they started too low in the first place. Nurses have always been underpaid. When I think of some of the things which have been said on the benches opposite—my hon. Friend the Member for Holborn and St. Pancras, South (Mr. G. Johnson Smith) referred to them as somewhat hypocritical—I recall that one could produce figures from the days when right hon. and hon. Members opposite were in office which would burst many of the bubbles which have been blown today.

It is a tragedy that the negotiations and discussions on nurses' pay were caught up in the present incomes policy. If only the early negotiations had got on more quickly and not been bogged down, an improvement for the nurses, I feel sure, would have been in the pipeline and they would have been offered more than the 2½ per cent. When my right hon. Friend the Minister of Defence announced the increases for Service men, with which we all agreed, the case was no stronger than the argument which can be advanced in support of the nurses now.

I agree with every word said about the importance of the incomes policy. It is vital for the country, and, of course, the nurses themselves will be among those who will benefit most from its success. Nevertheless, it has never been intended to be completely inflexible. The noble Lord the Minister for Science has said, "Let us get off the 2½ per cent. hook as soon as possible". The noble Lord, Lord Newton, speaking for the Government in the other place, said that
1010
the 2½ per cent. offer was in no way a reflection of the value that the Government put on the services of nurses.

In his Budget statement the Chancellor of the Exchequer said that it was hoped that we should be able to get rid of some of the anomalies which are being caused by the early stages of the incomes policy. I say, "Let us get off the 2½ per cent. as soon as possible. Let us give some reflection of the value which the Government put on the services of the nurses, and let us deal with this particular anomaly as soon as possible."

One of the reasons why the Government are rather unpopular at present, I think, is that we have, perhaps, got our wages and salaries priorities wrong. We may well have a wonderful opportunity now to enlist the co-operation of the T.U.C. and the employers and to put our priorities right. I do not begrudge industrial workers the enormous benefits which some of them have received. I am well aware of the important part they play in productivity and the increase of exports. But surely they should be prepared to mark time for a bit on their wage claims. Though many grumble at the Government's incomes policy, I feel sure that none would urge their claims before those of the nurses.

The whole Committee must appreciate the Minister's acceptance of the Motion on the Order Paper signed by my hon. Friend for Maidstone (Mr. J. Wells) and many others, including myself. We are grateful also for my right hon. Friend's initiative in undertaking a further review of the situation. Let us hope that, in the not too distant future, nurses and midwives will receive a little more just reward for the magnificent services which they render.

I am still in some doubt, at the end of his speech, whether the hon. Member for Chichester (Mr. Loveys) supports the nurses in their fight for improved wages or not, and I could say the same about the speeches made by many hon. Members opposite today.

I take it from that that the hon. Gentleman does support an increase for the nurses. I am very pleased to hear it, because he did not make it clear in his speech.

In our previous debate on 27th March, the Minister was very careful not to say that the staffing position in the National Health Service was satisfactory. It is fair to him to say this because several hon. Members who have spoken today have contended that the effect of his remarks was otherwise. The right hon. Gentleman rested his case on the increases in staff which, he said, were occurring. He said that
The overwhelmingly important fact is that in every sector we see expansion".—[OFFICIAL REPORT, 27th March, 1962; Vol. 656, c. 1100.]
I wonder whether the Royal College of Nursing agrees with that statement. I have seen figures which show that in 1961 the numbers of both trained nurses and student nurses fell. It is true that, since 1949, there has been a quite substantial increase, but the increase in numbers has not by any means led to an improvement in the efficiency of the service, for various reasons which have been mentioned—the increased rate of turnover of beds, the development of new techniques of nursing, and, of course, the reduction in working hours. The fact remains that we still have an estimated 25,000 vacancies for nurses and midwives alone, quite apart from vacancies for other professions within the National Health Service.

To continue on this subject of vacancies, on 12th March the Minister was asked to give the cost which is now being incurred in advertising vacancies in the nursing service and the total cost in 1961. His answer was:
I regret that this information is not available."—[OFFICIAL REPORT, 12th March, 1962; Vol. 655, c. 877.]
I, too, regret that it is not available. I am more surprised every time I think about this that the Minister has not demanded to know what is this figure from the sources that he has available and that he should admit to the House the fact that he does not know it. What business could possibly be run on those
1012
lines? Surely these figures are kept by the regional hospital boards. This raises the opinion in my mind that the figure, if it could be given, would be so astronomical that there would be a public outcry about it. If there were more nurses and there were not the present staff shortages, the regional hospital boards would not have to spend the sums on advertising which they are doing today.

The Minister told us also that he believed that the publication of the Hospital Plan would be in itself a great asset to further recruitment in the service. I am reminded of the story that when the Duke of Wellington was accosted by a stranger in the street with the words, "Mr. Smith, I believe?", he replied, "If you can believe that, you will believe anything." I say the same thing about the Minister's opinion on the effect of the new Hospital Plan on recruitment. Even supposing that recruitment and staff levels in the National Health Service were satisfactory at the moment, would this be a valid reason for refusing pay claims when the nurses are so much worse off than other sectors of the community? This was the inference that I drew from the Minister's speech on 27th March and again today, because of the great emphasis that he laid on the factor of recruitment and the improvement which he said was constantly occurring. I state my abhorrence of a principle which, if accepted, would penalise all those professions where the ideals of service and vocation are strongest.

I was not surprised that the hon. Member for St. Pancras, North (Mr. K. Robinson) said that many nurses are emigrating or that the hon. Member for Sheffield, Brightside (Mr. Winterbottom) referred to an advertisement in the Globe and Mail overseas edition, which I think that I must have read if it was that of 9th May. I turned the salary mentioned there into British terms and it came to £1,200 per annum, with room, board, laundry and uniform deductions of £130 per annum (which is a good deal less than the nurses pay in our hospitals) for a 40-hour week, with sick leave and pension scheme. When we contrast this with the maximum of £1,100 being asked for a ward sister, not a staff nurse, we see how far behind these people we are. I am not surprised
1013
when they leave the National Health Service for other employment. Even if they remain in nursing, the opportunities open to them in industry are much greater.

I should like to read to the Committee a paragraph from a letter that I received from a matron:
A male nurse, who commenced training in 1952 and undertook the two year training for State Enrolled Nurse, continued for 2½ years to gain his State Registration and worked for six weeks as a Staff Nurse prior to taking a year's post-graduate course to equip him with extra opportunity for promotion at a later date, has since completed four years plus, as an Industrial nurse, and is now seeking reappointment in hospital, finds that his salary would drop from his present figure of £988 per annum to £525 with 5 annual increments of £21 and one of £26 to a maximum of £656 per annum.
I very much doubt whether this hospital will be able to attract him back from the position that he has taken in industry.

The Minister said in the debate on 27th March:
The nurses and all other sections in the National Health Service are not being called upon to take part in a policy which does not apply to the nation at large."—[OFFICIAL REPORT, 27th March, 1962; Vol. 656, c. 1101.]
I totally disagree with this, because between the fourth quarter of 1960 and the fourth quarter of 1961 wages and salaries rose from £3,505 million to £3,725 million, an increase of more than 6 per cent. Those are the figures given in the monthly Digest of Statistics No. 195, on page 2. This also invalidates the argument put forward by the Minister that no one has more to gain from the success of a national incomes policy than the professions themselves. In the race against inflation, it has always been the professions that have been left behind.

The hon. Member for Chichester also made this point, and Mr. Michael Fraser, who is the Director of the Tory Research Department, in a letter to The Times on 17th April, made the same point:
If all incomes were now to show a substantial rise not only would our competitive position be worsened but prices would rise and teachers and nurses would find their gains eroded.
I think that that shows where the gramophone record comes from. Surely the nurses have no gains to erode. The Government have not exercised control over wages and salaries over the whole breadth of the economy, and the effect
1014
of the Government's policy is to worsen still further the relative position of people in the professions. I have never before in my life heard a more specious argument than the one put forward now, apparently as official Tory policy.

I asked a Question this afternoon and I have been given the figures. These show that since 1949 the State enrolled nurses had a fall of 2 per cent. in their wages adjusted to take account of the drop in the value of the £, staff nurses had an increase of 3 per cent. and ward sisters an increase of 9 per cent. If we compare these with the average weekly earnings of women aged 18 and over in the same period in industries covered by the Ministry of Labour's statistics, the figure is 31 per cent., so we see how these people are getting left behind in this race, and how totally inaccurate is the contention made by so many Tories.

The cavalier fashion in which the claim of the nurses has been treated is another factor which has caused great resentment. It is not necessary for me to recapitulate the details, because the hon. Member for St. Pancras, North has dealt with them already. I should like to point out an interesting comparison between this claim and that submitted by the medical photographers. Their claim was submitted on 31st July, 1961, and on 17th October an agreement was reached on increases ranging up to 22 per cent. That shows the difference in treatment that occurred there.

I agree with the hon. Member that that is in fact the case. Fortunately a great deal of public attention has been given to nurses' salaries over the last few weeks. The newspapers have given very wide coverage to the protest that has been made and there was even a television programme the other day about a hospital in my constituency. I do not know whether that was the result of the remarks which I made in a previous debate. Unfortunately I missed the programme. I was in Montgomery at the time.

The campaign has brought home to the public the unbelievably low salaries
1015
of the nursing profession, which I do not think were generally realised by the public before this, and also the fantastic hours that some of them have to work. I am not talking only of nurses employed in hospitals. I would mention in particular district nurses, because I know the kind of hours which they work—that is to say, anything up to eighty hours a week. I have seen figures which have been produced by a district nurse showing the consistently long hours which she has to work. Hon. Members should remember that this is particularly tiring work because there is a great deal of driving involved.

In passing, I refer to one particularly distressing consequence of the niggardly salary policy which has been followed recently, and that is that it is quite impossible for nurses who are resident in hospitals to save enough to buy a house on the salaries that they receive. Also when they retire it is not possible for them to get their names on any local authority housing list because they have not been qualified by residence, which is a prerequisite for being placed on the housing list of almost every local authority.

It has been said that it is impossible to measure the work of the nurses as one might be able to do, for example, with a capstan lathe operator. Therefore, the criterion of increased productivity, which I believe is the only reason given in the White Paper as valid for the granting of an increase, would not operate with the nurses.

I do not believe that the White Paper on Incomes Policy: The Next Step, should be dignified with the name of "policy". The hon. Member for Tynemouth (Dame Irene Ward) called the White Paper the most mamby-pamby paper she had ever read. While I might not have chosen quite the same adjective as she did, I think that the sense of what she was trying to convey was an expression of opinion with which I myself might agree.

To revert to the question of productivity, in the case of midwives we have a measure, because between 1955 and 1961 there was an increase of 20 per cent. in the number of births. I have been given the figures; there were 683,640 births in 1955 and 819,463 in 1961. But the number of midwives
1016
practising in these two years was exactly the same. Therefore, if we are basing claims on productivity alone the midwives should have had an increase of 20 per cent. in real terms between 1955 and 1961. It is well known that there is an acute shortage of midwives today. The Minister must agree that in this field at least it is not possible so to arrange the figures to prove otherwise. The general remarks which I made earlier apply with equal force to the other professions within the National Health Service.

As to staff shortages which are being experienced, I should like to mention in particular the shortage of physiotherapists which is being experienced in Orpington Hospital. We have only seven, including part-timers, as compared with an establishment of sixteen. This depletion of staff has had many serious repercussions about which I should like to tell the Committee. There is less intensive treatment of in-patients, resulting in longer occupation of hospital beds than would otherwise be necessary. This in turn increases the load on the general hospital staff and adds to what one might call the hotel costs of running a hospital.

Also—and this is a very serious matter—there has had to be a curtailment of the treatment at the rehabilitation day centre. Indeed, there is a danger that this centre may have to close. The centre was started as an experiment three and a half years ago and it has been very successful in enabling patients to be discharged at an earlier date than they otherwise would have been. Furthermore, it has enabled some patients, who otherwise would have had to be treated in hospital, to remain at home. It would be a great pity if these services had to be withdrawn, particularly when the Ministry of Health strongly advocated the treatment of patients in their own homes rather than in hospital.

I do not believe that the Minister appreciates the resentment which has been aroused by his treatment of the nurses. The whole nation has rallied behind them in their fight—the whole nation, that is, except for a few Scrooges in the Tory Party who still persist in repeating sanctimonious nonsense about everybody being in the same boat. They forget the £83 million present, alluded
1017
to by various hon. Members, which was given to the Surtax payers last year—nearly twice as much as it would cost to satisfy the nurses' claim in full. When people ask where the money is coming from to meet this claim, I say not only is there that £83 million but there is also the £172 million which the Government are pouring down the drain in the independent nuclear deterrent.

Mention has been made of the token strikes in sympathy with the nurses. These may be quixotic and irresponsible, but I think the strikers may be forgiven for thinking that this is the only type of language which the Government understand. In its leading article today The Times contrasts the award to the dockers with the refusal of the claim by the nurses, and says:
Would the Government have behaved so sternly to the nurses if, as with the dockers, a serious possibility of a strike had existed from the start?
The question is rhetorical because the answer is so obvious.

The Government may make a distinction between dockers and nurses, but I do not believe the public does. Nearly ten months have elapsed since their claim was submitted, and now the Minister offers the nurses pie in the sky. If the Minister has let the management side off the leash to the extent that they can now negotiate realistically, why could not a sensible offer have been made in the first place? The nation demands an end to procrastination and double dealing, and a fair settlement for the nurses.

It is with particular pleasure that I follow the hon. Member for Orpington (Mr. Lubbock). When this subject was last debated on 28th March I remember listening with particular attention to the speech by the hon. Gentleman. He referred particularly to the Minister's speech and to the wages policy.

I should like to begin with a reference to the Government's wages policy. Much has been made in this and the previous debate on the Government's White Paper on Incomes Policy: The Next Step. My right hon. Friend the Minister of Health seemed to base his
1018
arguments both in the previous debate and today on the fact that the number of nurses was increasing and that, therefore, this was not an opportune moment to give them a rise, being out of line with the policy laid down by the Government.

Unfortunately, one does not find that statement set out in the White Paper. Paragraph 8 says specifically, under the heading "Shortages of labour":
In a fully employed economy there are bound to be scarcities of many kinds of labour. A shortage of labour within a particular industry or firm would not of itself warrant an increase in pay.
This statement has given me a great deal of concern. In principle, of course, I support the policy set out in the White Paper. I agree that if we increase our wages at a rate faster than the increase in productivity, it will lead to inflation, and that persons with fixed incomes and in a weak bargaining position, such as nurses, pensioners and teachers, will lag behind and suffer.

The White Paper states in paragraph 5, which is the main section of the statement:
It follows that there is no scope in 1962 for more than strictly limited increases in wages and salaries. In many cases there may indeed he no justification at present for any increases at all.
The paragraph continues:
In others there may be particular circumstances which point the other way.
I am now arguing, as I have done before, that the case under consideration is one of those other cases referred to in that paragraph. Almost everyone agrees that this is so and we have seen unprecedented examples of this agreement. Whether or not it is right for workers to strike is beside the point on this issue. Everyone agrees that nurses are a special set of people and I ask the Minister to consider giving them an increase which, in my view, need not necessarily set a pattern for other workers to follow.

We are dealing with a special category of people. No one would be so low as to base a wage demand on any increase that might be given to the nurses, over and above the 2½ per cent. Now is the time for them to be given wage increases. The Minister admitted in his speech earlier that nurses are not paid their appropriate salaries. Without entering
1019
into the pros and cons of this, or making comparison with people in other walks of life, the time is right for these increases to be made and to end this anomaly, for the White Paper does not instruct the Government to keep this anomaly in existence.

My right hon. Friend should examine this matter carefully, because the Government are not only losing the support of the workers; they are also losing the confidence of many people who previously supported them. There is no need for my right hon. Friend to keep in existence an anomaly just for the sake of a statement—an anomaly which is in no way required.

The hon. Member for Orpington referred to a survey into nurses' pay. I have with me a publication issued by the International Council of Nurses. It concerns 41 countries—from Austria to the United States—and a study of this document shows that there is no other country in which nurses are paid as poorly as they are in Britain. In most countries their salaries have been increasing. In Denmark, they have increased by 70 per cent. since 1957, compared with the fall in real value in this country. They have increased by 45 per cent. in Sweden while, in paper terms, they have risen by only 25 per cent. in the United Kingdom.

Countries throughout the world—not only in North and South America, but in the Far East—are trying to bring the standards of living of their nursing staff up to better levels. As my right hon. and learned Friend the Member for Hertfordshire, East (Sir D. Walker-Smith) suggested, a Royal Commission should consider the deficiencies in nurses' pay. There is need for such a study, but I suggest that, apart from looking at that aspect of nursing, there is also need for an increase in the basic pay over and above that which has been offered and which the nurses have rejected.

The nurses' claim has been under consideration for more than nine months and it seems that we as a country are exploiting a profession which has stated that it does not want to strike and does not want others to strike on its behalf.

It is a publication issued by the International Council of Nurses. It is the 1961 issue, the most recent, and consists of reports by its member associations. It is published by that Council, the address of which is Dean Trench Street, S.W.1.

I have some special knowledge of nurses' work, because my wife was a nurse and I once spent some time in a London hospital, where I received excellent treatment from the nurses. We have managed so far in this debate to keep it above the wholly sentimental level. Not too much sentimentality has been introduced and the arguments have been based on reason and logic. Hon. Members who say that nurses are paid overtime are labouring under a misapprehension. While some mental nurses receive overtime pay, the majority of nurses do not. Until recently they have been working a basic week of 48 hours and have been putting in many extra hours in their breaks and spare time, doing jobs which sometimes were not required of them.

Incidentally, the jobs they do need reviewing, for these tasks include fetching from the stores—work which could be done by less well-trained persons. Another complaint of the profession arises from the policy of down-grading nurses who, after three or four years spent in qualifying, become State registered, but decide to specialise in particular branches of the profession, such as midwifery. Those who decide to specialise revert to the students scale of salary and this, of course, is not only iniquitous but discourages girls from taking up nursing.

I am occasionally asked, both in my capacity as an hon. Member and privately, whether or not a girl leaving school should go in for nursing. I say that if they enter the profession they will have to work hard, long hours and will be underpaid. I put the position frankly before them, although I know that many of them, because they consider it to be a vocation, will, nevertheless, take it up. Because these people are dedicated to their work, that is no reason why they should be underpaid. I hope, therefore,
1021
that is no reason why they should be underpaid. I hope, therefore, that my right hon. Friend will give them salaries which are fair, reasonable and just. This may mean an extra cost of £19 to £20 million a year—the figure referred to at Question Time today—for a 20 per cent. to 25 per cent. increase. It might mean that other workers will have to pay more for their insurance stamp, but I am sure that they would not object to doing this.

Workers in other industries have demonstrated clearly that they support the nurses. I feel sure that the average worker would not mind receiving a little less if it would mean the nurses receiving a little more. Whatever happens, there must be a reasonable and just solution to this problem of combating inflation, on the one hand, and of having an equitable policy, on the other.

Some hon. Members have referred to the National Economic Development Council, "Neddy", as it is sometimes called. The existence of this Council does not relieve the Government of their responsibility for fixing the wages and salaries of those under their control. I therefore suggest that the Minister should think very carefully about this matter. I welcome my right hon. Friend's statement today that the nurses are entitled to a 2½ per cent. increase straight away, that there will be a review of the differentials, but I should like him to go further. I should like the basic salary to be increased by more than 2½ per cent. An increase of 3 or 4 per cent. is the minimum which can, in all justice, be offered to nurses as a basic increase. I support the suggestion that the differentials should be re-examined.

Our aim should be to have the best possible nursing service. It may well be that we are getting a sufficient number of recruits from the Commonwealth, from the Irish Free State and from this country to fill the positions in hospitals, but are we getting the best recruits? There must be a very large number of hard working, intelligent and well-qualified girls leaving school who do not turn to nursing for a job, but who would do so if nurses were paid a little more.

There has been reference to the deductions which are made from nurses salaries, ranging up to £150 for nurses
1022
and even more in the case of sisters, for their keep, sometimes in nursing hostels, and for the provision and laundering of their uniforms. All these are minor irritants. There is a need for immediate reform in those instances which I am convinced would bring more recruits to the nursing service and which would enable teaching hospitals to make a selection from the best people available so that the best possible service is provided which would be the pride of the world. We can do that without in any way breaching our wages policy which is so essential for the economic future of the nation.

It is interesting to note that the powerful speech of the hon. Member for Belfast, East (Mr. McMaster) was the second that we have had from a Member who is married to a nurse. It is not surprising therefore, that the hon. Gentleman should be so well informed. Although I do not agree with his suggestion that an increase in nurses' pay should come out of an increase in the flat rate National Insurance contribution and regressive taxation, I agree with him that, whatever may be the problems concerning the differentials the problem of a general increase cannot be avoided.

The only arguments advanced in support of the Government's policy from the benches opposite—and there have not been many—have been those which sought to support the Government in their attempt to maintain their wages policy. For instance, the hon. Member for Ashford (Mr. Deedes) warned the nurses that they would get no advantage from inflation, because it would reduce the real value of their salaries. On the other hand, as long as we have a stagnant economy, which is apparently the only answer of the Government for preventing inflation, no increase in nurses' salaries can be afforded. They are, therefore, caught between the two horns of a dilemma. The Government cannot find a way out, because they are unwilling to take the risk of allowing the economy to expand.

The hon. Member for Ashford thought that the only thing wrong with the Government's policy was that they had not explained it. The opinion is growing that a thing can be as bad as we like,
1023
but provided we have public relations officers it can be made to seem perfectly all right. My wife, who is a psychologist, tells me that one thing it is not possible to do is to sell a face cream made of vitriol. However brilliant may be the propagandists in the Tory Central Office, and those expensive public relations men whom it employs, the Government will not be able to sell to the country the policy of a stagnant economy. I agree that, as long as the economy remains stagnant, the Government will be caught in this dilemma and will have to use the only instrument which they have available, which is to hold down wages and salaries in that sector of our economic life in which they have some power.

The hon. Member for Ashford—I am sorry that he is not here, since I am attacking him—supported the Minister and said that it was essential that in no circumstances should there be any breach of the Government's policy by a Cabinet Minister or by any other Minister. But, as my hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) pointed out, there has already been a major breach in their policy in the case of doctors in the Services. Once the breach has been made, it is no good saying that the Government present a united front. Of course, they do not.

We know that the Minister of Health is a fanatic on this policy. My hon. Friend the Member for Oldham, West (Mr. Hale) attacked him a little while ago for not resigning. We must, however, give him credit, because he did resign on a previous occasion in favour of the policy which he is now carrying out. I do not think that he can be defended on the ground that he is now supporting a policy with which he does not agree.

One of the most interesting speeches was the very powerful and apparently weighty speech of the right hon. and learned Member for Hertfordshire, East (Sir D. Walker-Smith), who was Minister of Health for some time. However, I do not think that he helped us very much. All he said was that we should have a wages policy and finally came down in favour of a Royal Commission. Some hon. Members supported what he was saying, but I do not think that they understood what he was saying. He did not say that there should be a Royal
1024
Commission to examine the structure of nurses' salaries. He said that there should be a Royal Commission to examine how large the social services should be and how they should be paid for.

But this is the matter which divides the Committee. It is a matter of policy. It is a question of how much of our national income should be used for public expenditure and how much should be used for private expenditure. No Royal Commission, politically neutral so-palled, can take away from this House, from Ministers, or from the Opposition the duty of making up their minds on the proportion of the national income which should go to the social services. A Royal Commission might be useful if it looked into the structure of nurses' pay, but heaven help them if one is set up and nothing is done in the meantime, because they will not get anything for the next few years. A Royal Commision is not the sort of body which should determine the distribution of the national income or how the social services should be paid for.

There is no doubt about the cause of all the bitterness of feeling engendered in those employed by public authorities, especially in those with the strongest traditions of public service who are being used as the instrument of Government economic policy. So strong is this feeling that it is having very serious electoral effects for the Government. In attempting to get out of this, the hon. Member for Holborn and St. Pancras, South (Mr. G. Johnson Smith) has tried to use the old Tory principle of divide and rule. The hon. Member tried to invoke in the nurses and in their organisations an antagonism and hostility towards the trade union movement and the manual workers, who, it was said, were getting enormous increases in wages.

In fact, the manual workers' unions have been very moderate in their demands since the war. If one makes a comparison between what they have received and the increases in profits and dividends, particularly in certain sectors such as land ownership, all this talk is complete nonsense. In applying this divide and rule principle of Tory policy, the hon. Gentleman went even further. He tried to divide the nursing profession itself by what he had to say about the differentials. It is not that the question
1025
of differentials is not important, but his whole approach was such as to try to destroy the new united front which the nurses are showing.

The Government's policy of interfering with the wages and salaries of those in public service is not a new policy, for the Government, or for the Health Service, because it was started by the right hon. and learned Member for Hertfordshire, East in 1957, when, as Minister, he vetoed an increase for lower-paid staffs in the hospital services which had been agreed as an interim measure after Sir Noel Hall's Report on Salary Scales in the Health Service. Time and time again the Government have forced the staff side of the Whitley Council to go to arbitration, involving lengthy delays before any agreements could be arrived at on hospital salary scales and structure.

There has been a continued interference with the Industrial Court, not directly but through the pressure of which we all know so well. The confidence in the independence of the Industrial Court has been lost. Not surprisingly, those in the public services, including nurses, do not want to go to arbitration. The hon. Member for Tyne-mouth (Dame Irene Ward) referred to the reluctant way in which the Royal College has accepted this and then only on condition of some interim payment. The attitude of the Royal College demonstrates the feeling that exists.

Since 1948 there have been over 60 arbitrations affecting the non-manual staffs in the Health Service. In the same period there have been only three in local government. If there have not been many in the nationalised industries, it is because Ministers have intervened much more directly there than elsewhere.

I intend to speak mainly about nurses' salaries and conditions, but there is also a problem which anybody serving on hospital management committees knows of, of the professions supplementary to medicine, which my hon. Friend the Member for St. Pancras, North dealt with eloquently in our last debate on this matter. This is a serious problem. It is one which affects not only the hospital service, but any other profession in which there is a growing technical expertise and a growing need for education and training. It applied in the case of hospital
1026
technicians, although they have received a substantial increase in recent months. There is still a great need for further increases in other professions, such as physiotherapists and radiographers, because their work in the hospital service is growing all the time and they are performing tasks which were not even thought about twenty-five years ago. They can save the valuable time of doctors and other professional staff by the work they do.

The profession of nursing illustrates the difficulties of many traditional occupations. The problem arises largely out of the profession's history. It is not peculiar to this country. Last year, I had the privilege of attending the International Congress of Nurses at Melbourne and I heard some of their discussions and met about 2,000 nurses. Anybody attending that Congress could well understand the problem.

In general, the profession is underpaid. Its salary structure is related to an outmoded method of organisation and work and it has difficulty in recruiting new entrants. This is not unique to nursing. It is typical of many of the older professions and industries.

I want very briefly to go through the various positions in the nursing profession. Starting at the top, it has been said that matrons do not present a serious problem. But they are not overpaid, and anybody who has had the job of trying to recruit matrons for large hospitals knows that it is very difficult to get sufficient applicants. It is partly the salary question and partly due to the fact that many good nurses are unwilling to exchange nursing—the profession they love—for what is becoming a work of administration of increasing responsibility. If this is the case, the salary structure for matrons must be reconsidered.

Many hon. Members have referred to the fact that the most serious position at present is in relation to trained nurses, staff nurses, and particularly ward sisters. I do not want to go in detail into the question of differentials, because I am not qualified to do so, but there is no doubt that the differential between the three-year student nurse and the staff nurse is inadequate. It is just over £100, whereas it should be nearer £250. It is also probable that the length of the
1027
scale is too long. The ward sister, who occupies the key post in the whole nursing hierarchy, should certainly receive a further differential.

I find myself in more difficulty about student nurses. Here, the problem is concerned with the whole organisation of the nursing profession. If the salaries for student nurses were paid merely in respect of their being students they might be regarded as adequate, but that is not the case. In all our hospitals the bulk of the nursing is done by students and their training is simply piled on top of their work. We are doing in respect of the student nurses what we do in industry for apprentices, namely, using them as cheap labour. That being the case, they must be regarded as being inadequately paid.

But it is more than that. The system is not a very good one. We give them the appearance of responsibility, but it is only the appearance, because one of the problems in the profession is that nurses are often not allowed responsibility even in accordance with the training they receive. These girls are very young. They are often very immature, and have great difficulty in adjusting themselves to the emotional stresses of a hospital ward. Having said a great deal to show my sympathy with the nurses' claims, I now wish to say something which is slightly critical. This situation often leads, in later life, to the adoption of the wrong attitude towards patients. It sometimes leads nurses to take up rather authoritarian attitudes. It also leads to great wastage among student nurses.

Recent studies of the work of nursing show that about two-thirds of the time of the nurses is spent on routine jobs which do not require a high degree of professional skill. That point was made in an article in today's issue of the Guardian. What they need for these jobs is manual dexterity, some training but, even more important, a secure emotional outlook. I doubt whether this need will be fulfilled by the growth of numbers of the State-enrolled nurse.

I like the idea put forward in the Nursing Mirror a few weeks ago, of recruiting mature women and giving them a training of a practical type, taking into
1028
account their maturity and their experience of life. Other professions than nursing have had to face the fact that as the scientific content of their profession has increased there has been a need to develop different grades of practitioner. The highly trained nurse will become more and more necessary, and should be given more and more responsibility.

At the moment, nurses are brought into the profession and told that it is one of great responsibility, and yet they are not allowed to use any initiative of their own. The doctors keep them very much under control. As higher educational standards are required for entry to the profession, and with longer training and better training, the highly qualified nurses should be given much more responsibility.

There is also a need to recruit others without the same educational background, whose personal qualities make them suitable for daily attendance on the sick. In the long run arrangements of this sort will lead to a more efficient, economic and humane nursing service. But this is not a recipe for saving money in the short run. There can be no scheme of reorganisation of the nursing profession, or its salary structure, except in a climate in which trained nurses feel that they are being adequately paid. We cannot have a reorganisation involving the giving up of established attitudes if the whole profession feels that it is under pressure, or that it is being badly treated. We can have changes of the type that I have described only if there is a general increase in salaries all round.

Hon. Members on these occasions often refer to nursing as a vocation, and everybody says, "We must not take advantage of them; we must pay the nurses enough." If they are taken advantage of it is partly the nurses' own fault, because of their very great traditions and their memories of Florence Nightingale. One has only to read the nursing journals to realise the almost impossible ideals that they set themselves. But it is not healthy for nurses or patients if nurses should feel that they are making a special sacrifice by being nurses and are, therefore, in a superior position to that of their patients. Nursing, like other professions, should
1029
receive the reward which the community considers just for its services. If it receives that reward I am certain that the relationship between the nurses, the patients and the community will be better than it has ever been.

The very simple question which we are debating today is whether nurses are adequately paid for the job they do. If we are all honest and we eschew all party considerations the answer can only be, "No, they are not." I am a member of the Goodmayes Hospital Management Committee and although I do not claim to be expert in these matters, I claim to have some knowledge of them. It is a pity that sometimes hon. Members on both sides of the Committee use the language of exaggeration in support of a case, because I am perfectly sure that when we resort to that kind of tactic we disclose a weakness in the case which we try to put before the Committee.

I have been criticised twice this evening for making statements about overtime pay for nurses and I frankly admit that I was guilty of over-generalisation. In order that we may have the record right I should like to say exactly what the position is. Nursing staff working an 88-hour fortnight on shift duties, student nurses and nursing assistants are paid overtime at plain rates. Staff nurses, charge nurses and sisters receive no pay for overtime but most of them receive equivalent time off in a subsequent period. This is and has been the position for some time in general hospitals as a whole, but there has been this difference in mental hospitals in that it has only been within the last few months that nurses in mental hospitals have not received payment for overtime.

I am much obliged to my hon. Friend for giving way so early in his speech, but is he aware that the rule which he mentions is almost universally ignored and that neither trained nor student nurses receive overtime except, in the past, mental nurses, for the many hours extra that they put in at night or at the weekend?

The conditions of service which I have outlined are laid down
1030
in the Whitley Council for the Health Service, Circular 94. If those conditions are not being observed, then the recommendations of the Whitley Council are not being observed.

At this early stage in my speech, I should like to call attention to a speech made by the hon. Member for Willesden, West (Mr. Pavitt) when we last debated this subject. I have already given the hon. Member notice of my intention to raise this point. In that speech the hon. Member drew attention to the situation in the Goodmayes Hospital, and he said:
In 1960 we had 12 student nurses in and 13 out, and eight of those who went out did so because of pay. In 1961 there were 14 in and 10 out, and seven of those who left did so because of pay. In 1962 to date, only three months, there have been four in and six out, and five of those who have left have done so because of lack of finance.
As a statement of fact that is correct, but it deals with male nurses only and has no regard whatsoever to the female staff in hospitals.

The hon. Member went on to say:
We can readily understand this when the rates of pay are known. A qualified male nurse in this hospital, first-year resident, doing shift work and working a seven-hour day on a Sunday, has a take-home pay of £6 12s. after deductions.
It was far better to be an entrant ward orderly who
… on exactly the same conditions … took home £10 11s."—[OFFICIAL REPORT, 27th March, 1962; Vol. 656, c. 1282–3.]
And that was without the need for three years' training.

Again these are statements of fact, but the real truth is simply that the £6 12s. refers to a nurse resident in the hospital in the first year of his or her employment after finishing student training. The figure of £10 11s. refers to a ward orderly who has no prospects under the existing Whitley Council pay proposals of £10 11s. and who is non-resident at the hospital. These are essential and vital differences in the two pay positions.

I am sorry but I have not the figures for a general hospital, but since the figures I have before me are
1031
Whitley Council recommendations I feel that they largely represent the figures which also apply to general hospitals. What I am really getting at is that it is simple and easy to quote one figure and to relate it to another without giving the exact parallel between the two.

I simply tell the Committee that the figure of £6 12s., to which the hon. Member referred, was for the first year of pay to a nurse aged 22, male or female, commencing work after three years' training, and it is also after having paid for or having deducted from the pay the full complement for housing, food and laundry. The figure of £10 11s. is for the ward orderly who has no qualifications and who has out of that to pay for his home and his food. The two things are not parallel at all. I am not suggesting that either is overpaid. I suggest that both are underpaid, but I am saying that we ought to get the two figures into correct perspective.

If we are to use the expression "relatively" it should be remembered that the first figure of £6 12s. which I quoted is the first year take-home pay after accommodation, food and laundry. I would say that that bears a fair relation to the figure of £10 11s. because I find it difficult to believe that any man these days could find himself accommodation outside the hospital and feed himself and possibly a family and have his laundry done for £4 a week, which is in effect the difference between the figures. Using the hon. Member's own term. I would say that £6 12s. relative to £10 11s. is probably reasonable, but I repeat that I am not suggesting for one moment that either figure is excessive. We must do very much more for both these people than we are doing at present. The purpose of my argument is none other than to put these matters into perspective.

I apologise for interrupting, because I have not heard much of the debate, but I am interested in what the hon. Gentleman is saying. For what purpose is he going into these compara-
1032
tively minor differences of degrees of misery? If it is common ground that one may be a little better, or the other is a little better, but both are hopelessly inadequate, why cannot the hon. Gentleman be content with that?

The hon. Member for Nelson and Colne (Mr. S. Silverman) is an adept politician. I am doing this for no other reason than to rebut the argument put forward by his hon. Friend the Member for Willesden, West which received a great deal of national publicity.

If it was right for the hon. Gentleman's argument to receive publicity, it surely is not out of order for me to rebut it and to show the true facts of the situation. There may be two horses in this race, but the hon. Member for Nelson and Colne cannot ride both at once.

I am not doing anything of the sort. I am trying to put the facts before the Committee to let the Committee judge what is the proper position. I said at the start of my speech, and again a little later, and I repeat now, that nurses and nursing orderlies are underpaid. I do not think that I can say this with any greater emphasis. All that I am trying to do is to put before the Committee the real issues facing us at the moment.

The Committee should understand the present position. A student nurse starting her training at 18 receives £352 in the first year. If she is in residence she has deducted £130 for food, accommodation and laundry. This leaves her a take-home pay of about £6—say £5 in round figures. This is not a very princely sum, but I remind the Committee that it was not so long ago—within the last quarter of a century—that men were indentured into certain professions and that parents paid an apprenticeship fee for their sons to learn the trade that they would follow throughout their lives. Those times have changed, and I am glad to see that they have, but the fact remains that during the three years from 18 to 20 the real
1033
service which a hospital gets out of a student nurse is relatively small, because she is still under training and is quite obviously—and this is no reflection on the girls who do a wonderful job—unable to do work without some kind of supervision.

Does not the hon. Gentleman realise that when these girls start their training at 18 they do so having stayed on at school until that age and having sacrificed the chance of earning any money? Does not he also know that many student nurses work extremely hard, and in many cases accept responsibilities which they ought not to do? Does le suggest that £6 take-home money at 18 is sufficient, remembering that these girls could earn very much more in industry?

—and I claim to know something about this matter. When the hon. Lady talks about take-home pay, we must understand what this means. It means exactly what those two words imply, that the nurses or students have then paid for their accommodation, their food, and their laundry, and that this represents spending money.

It can be said—and I admit that the argument has some validity—that that is not very much spending money, but at least what they have in pocket is theirs. They have no other obligations to meet. I am not supporting these figures. I am simply trying to explain the present position. We are a Committee of the House of Commons. Our duty is to be swayed, not by emotion, but by facts and the realities of the situation.

I wonder whether the hon. Gentleman, in his enthusiasm for facts, would allow me to correct something he said. He said that the hon. Member for Stoke-on-Trent, North (Mrs. Slater) was referring to a "take-home" of £6 a week, and that was after the deductions. But in her first year of training a student nurse receives £299
1034
and the deduction is £128, and so she is not by any means left with £6 a week.

The hon. Gentleman will have to do a little more homework on that. At 18, in her first year, a student nurse gets £352, and if she is resident in the hospital, there is a deduction of £130, which leaves £222. I agree that that is not £6 a week, but I was doing some quick mental arithmetic whilst I was speaking. By the time she is 20 and has finished her training, she gets £389 a year with the same £130 deduction. She proceeds at 21 to her first year as a trained nurse, when she gets £452, and the deduction then becomes £158. At the end of her third year she gets £494 with the same deduction.

After that, the nurse has the possibility of qualification. I think that my right hon. Friend must give some consideration to the difficulties which then arise. In certain types of hospital it is relatively simple for male nurses but very difficult for female nurses to obtain promotion from this stage. This is particularly true in mental hospitals, where there is a greater demand for male nurses. In general hospitals, it is easier for female nurses to get promotion.

This situation arises out of the general question of equal pay. It will be found that whereas a large number of female nurses may feel reasonably pleased—I will not say any more than that—with the salary they receive, for a married male nurse with children the salary on the equal pay basis is very bad indeed. This is one of the prime reasons why we lose so many people, particularly male nurses, from the profession.

Just how this situation can be resolved is difficult to say. For reasons of accommodation, it is not possible at all hospitals for male nurses to live in. If a male nurse has to live out and has to pay very much more for his accommodation and also deal with his children and so forth, his conditions relative to the female resident nurse are obviously bad. The only possible solution is that a married male nurse who is nonresident should have more than the female nurse.

I have not the slightest doubt at all that the reverses which the Conservative Party has suffered during the last week
1035
or so have very largely—probably to the extent of 10 or even 20 per cent.—been the result of this campaign with regard to the nurses. That is not a reason why we should reverse a policy if we think it right. Our own party political interests should not be the main consideration in deciding what we should do on any one issue.

Nevertheless, rigid adherence to a particular policy which would appear to be inconsistent with the realities of the situation is not something which we in Parliament should support. When my right hon. and learned Friend the Chancellor of the Exchequer announced his wages policy, which, at least in the composition of the N.E.D.C., appeared to attract some support from the trade union movement, it did not necessarily follow that the figure of 2½ or 3 per cent. should be applicable over the whole economy. Let us be realistic about this situation. There are many people who, by virtue of their job, cannot possibly have any effect on the nation's productivity—the village postman, the school-master and the nurse are examples. Did I hear an hon. Member say, "The bookmaker"? There are many people, possibly about one-third of the insurable population, who can have no direct effect on the nation's productivity. Are we to say that those people should be equated to the rest of the economy?

We have to think quite seriously about our priorities, as my hon. Friend the Member for Belfast, East (Mr. McMaster) said. We have to decide which section of the community we must support and how much we as taxpayers and ratepayers are prepared to support above all else. If we think about it in those terms, we come back to the school teachers and the medical profession. These sections of the community are the sections which are vitally important to the well-being of the nation and are sections which we should go out of our way to support. If I were asked what I thought a fair increase for the nurses at this time, I should not be prepared to say, but I should be prepared to say that it would be very much more than the 2½ per cent. being offered.

Notwithstanding my right hon. Friend's speech earlier, I am not so much concerned with whether the Government
1036
feel that an inquiry or arbitration is the right way, or whether they themselves can make a direct offer so long as the end result is that the nurses, both male and female, get a substantial increase over their present standards. I shall support my right hon. Friend in the Lobby tonight, but I am bound to say that that support is conditional. Unless there is something adequate for all concerned within the next three months, there are many of us on this side of the Committee who will have to reconsider our position.

As is well known, I have not yet revolted against the Government. That is a form of inverted snobbery, like voting Liberal, or not having a television set, or having a Kleenex in the back of the car. Whatever it is, I do not intend to oppose my right hon. Friend tonight, but I impress upon him that this debate is regarded by many of his right hon. and hon. Friends as very important and that we expect some action and expect it quickly.

I have been in the Chamber since half past two, waiting for the hon. Member for Ilford, South (Mr. Cooper) to make a speech, because he was kind enough to do me the courtesy of telling me that he proposed to attack my contribution to our previous debate on nurses. The result is that I now have only five minutes in which to reply to him, and I hope that the Committee will forgive me if I cannot deal with his argument as thoroughly as I would like. I was very worried when, for three hours, the hon. Member did not appear in the Chamber. I thought that he might have been taken ill and might have yellow spots in front of his eyes, as eight local government seats in his constituency "went Liberal" last Thursday.

The hon. Member has done precisely that of which he accused me. Having started to give one set of figures and circumstances when we were discussing male nurses, he switched over and began talking about female nurses. He has Circular 94 before him and knows the rates of pay in both cases.

I have to apologise for misleading hon. Members in our previous debate. I made one mistake in the figures which I gave.
1037
I gave the figures of £6 12s. and £10 11s., which are correct for male nurses and ward orderlies in general hospitals, such as the King George's Hospital, Ilford. In fact, those were the figures for orderlies. But I quoted them in the context of a mental hospital where the figures are higher. But that does not invalidate the argument by one iota. I agree with the hon. Member that both nurses and orderlies are grossly underpaid and we do not make this argument on behalf of the nurses to advocate a reduction in the meagre £10 a week which an orderly gets.

I was grateful to the hon. Member for Ilford, South, for giving me notice of his intentions. In turn, I have checked up my references for my statements in the previous debate. One of them was Mr. J. Soley, who is the chief deputy nurse at the hospital which the hon. Member mentioned and a member of the General Nursing Council. If the hon. Member for Ilford, South is prepared at any time to spare the time to meet Mr. Soley, I shall be happy to make arrangements and he can then argue out the figures to his satisfaction. In view of the hon. Member's speech, there will be a number of nurses only too pleased to meet him at any time and to put him right on some of his facts and opinions.

The hon. Member and others who have paid lip-service to the nurses and to their devotion to duty ought to have the courage to go into the Lobby with us tonight and vote against the Government. They make speeches about how marvellous the nurses are and how it is more in sorrow than in anger that they have to support the Minister. Why not have the courage, if they support the nurses, to support them in the Lobby?

The hon. Member has asked for facts, and I have brought him some facts. I want to quote three cases of nurses in his own hospitals. I have permission to quote them. Indeed, I have their pay slips before me, which give some idea of the situation in the profession. The first is Richard Ivers, aged 19 and married. His pay slip shows £8 14s. 3d.,
1038
which includes 17 hours' overtime, which means that he worked 61 hours for £8 14s. 3d. He is a married man, and he has given me his bills, but I have not time to quote them, although I could show the House how he divides the money out. My right hon. Friend the Member for Middlesbrough, East (Mr. Bottomley) has also given some figures.

The second case is that of Mr. Philpot. He has given me his pay slip, showing £9 14s. 2d. He is a third-year student, and he tells me that he pays £4 in rent, £2 for electricity and £3 10s. for food. The total of his bills is £9 14s.: balance in hand, 2d.

The last case is a man of 33, also in the same hospital, Mr. John Laws, who is just completing his third year. His pay slip shows a total pay of £9 11s. 1d., which includes £1 1s. 4d., or less than 4s. an hour, for five hours' overtime. The point which I wish to make is that the Committee is missing the impact of these appalling conditions upon what is happening in the hospitals to the nurses and to the patients.

Mr. Laws works in the Goodmayes Hospital. He goes there at 7 a.m. and works a full stint until 4 p.m., and then he does five hours in a locked ward. This means that he starts at 7 a.m. and finishes at 9 p.m., for which he gets an extra guinea. He is doing this at the end of his day's work in a locked ward with 46 disturbed patients and three nurses, one of whom is qualified and another of whom is an unqualified Pakistani who cannot speak the English language. This is at a point where the alertness and the qualification of the nurses determine whether trouble breaks out. I ask hon. Members whether they would be prepared to do the same kind of thing for less than 4s. an hour. I have a complete case which I had hoped to deploy for at least another ten minutes, but I have not the time.

As we have heard from both sides of the Committee, the blame has been fairly and squarely placed on the Minister. I hope that the Ilford Recorder and the Ilford Pictorial will record that no blame is being attached to the hospital management committee; its members are servants of the Minister and can operate only within Circular
1039
No. 94, which has been sent to them. I am in no way trying to denigrate the voluntary work being done by the management committee. I say that Government policy is irresponsible and that, especially in mental nursing, it may lead to a gigantic breakdown. All the hopes which we had for a break-through and for new horizons in helping the mentally sick in the community are being stultified because of the Minister's obsession with financial matters.

I hope that I shall not be misunderstood, speaking as a Welshman, when I say that I have always had the greatest admiration and affection for the English people. I lapse from grace for an hour and a half every year, either at Cardiff Arms Park or at Twickenham, but, on the whole, I have a great affection for them. I have, however, detected one curious trait this afternoon—the extraordinary fear of Englishmen about emotion. They seem always to be smothering their consciences by being afraid of being emotional. I like a bit of emotion. I am all for it.

I say at once that one cannot approach this debate without at least some sentiment and same emotion. I am sentimental enough to believe that we cannot deal with a profession such as nursing in exactly the same way as we deal with any other body of workers. They have not the defensive mechanisms which other bodies of workers have. This is where the pay pause has become so stupid. The blanket approach which has been imposed on all wage and salary earners has brought within its influence people who are remote from the normal negotiations of conditions of service and of salaries.

The nursing profession, in a sense, is powerless against anything which the Government may impose upon it. Male and female nurses cannot work to rule, they cannot go slow and we all know that they cannot go on strike. We all know that it is beyond anyone's imagination that the Great Ormond Street Hospital should be left without staff. It would be absurd to suggest such a thing.

It is these facts which make ordinary, rough and sometimes tough men react against the attitude and the policy of
1040
the Government. It makes them react against the suggestion that advantage should be taken of the great virtues of the calling of the nursing profession. I say quite honestly to the Committee, as a trade union leader, that I do not want to see the nursing profession dragged into the roughness of industrial disputes. I do not want to see either male or female members of that profession having to talk the language which some of us have to talk.

I should have thought that it was a mark of a civilised society and of a nation which prides itself upon its Christian virtues that this profession, of all professions, which, in a sense, is incapable of defending itself by force, should be generously and properly treated. Productivity cannot be measured in a hospital. We cannot work-study compassion. How can that be done? The things by which we normally judge and base our arguments upon in wage and salary negotiations are outside the orbit of such a context.

The hon. Member for Holborn and St. Pancras, South (Mr. G. Johnson Smith) and others have said, "Pay is not all. There is this deep sense of vocation, this high calling". Of course pay is not all. They would not be nurses if it were all. That is why a civilised community must always offer protection, and generous protection, to these people and ensure that they have decent and proper standards of life.

I have spent much of my life listening to men on £3,000, £4,000 and £5,000 a year saying across the table to us, who represented men earning £9 and £10 a week, "It is your duty as a public service to remember that an increase at this moment would cause disaster to the nation". One of the most vivid memories of my industrial life is how austerity is always preached by those who do not know anything about austerity. I read a speech the other day by a junior Minister in which there was the invitation that nurses should remember that, if they wanted to enter the world and earn money, they should become secretaries or typists.

I repeat, I never mind listening to the language of austerity from the austere and I am always prepared to be disciplined in the virtues of saintliness by saints; but it is not very proper
1041
that professional politicians who enjoy a fair salary should so lecture men and women on low standards.

I want to say a few words about the conduct of the Minister. He made a speech over the weekend in which for about the first time, if not absolutely the first time, he revealed his basic philosophy. He unfolded to the nation what the party opposite stands for, "If a thing does not pay it is not worth anything". That is what he said, "If it is no good, wipe it out—if it does not pay".

The Government stand indicted on their pay pause, not only for the muddled way tin which they have handled it, not only for their incompetence, but for their insensitivity to the decencies to which ordinary people attach so much importance. It is a tragedy that the right hon. Gentleman the Member for Wolverhampton, South-West (Mr. Powell) is at the Ministry of Health at present. It is a tragedy that a man holding such a philosophy should be dealing with the humanities and those things which are born of compassion and tenderness.

The hon. Member for Holborn and St. Pancras, South said that he found it nauseating that trade unionists have protested against this when they were really responsible for the inflation. I could take the hon. Member to large sections of the industrial community which have certainly not had a fair deal over the last few years. But even those who have, even those who might have sinned, have been led in sin by the Government Front Bench. It is the hon. Member's own Government that have taught the people to worship false gods. At every General Election we have the statistical tables of washing machines, televisions and motor cars. The cry is, "You have never had it so good. Do not let Labour ruin it". Are the workers to be blamed for following the lead? What right have hon. Members opposite to blame them? Of course we are led into temptation. We know that we should resist it, but we are just as human as the hon. Member for Holborn and St. Pancras, South.

I wish to say a word again on the background of the argument, the pay pause. Many hon. Members opposite, and on this side of the Committee, have said that we cannot relate the ordinary
1042
negotiations of industry to these people; that they are outside those negotiations. I do not know where they stand now. The White Paper says, in effect, "In the past you had a lot to say about cost of living, but in the future"—these are the tablets brought down from the mountain—"the cost of living must not be considered too much. The cost of living is not a justification for a rise." I hope that my nursing friends will remember that the cost of living is not much.

The White Paper says that profit and productivity in industry cannot be considered. That does not affect nurses, because there is neither profit nor, I suppose, productivity in the nursing profession. It goes on to say that we can have an industry in circumstances where shortage of labour has in past years been used as an argument for increases in salary scales, but that is now out. I do not know on what basis any real claim can be justified, not only for the nursing profession, but for the rest of industry.

If we accept this advice I do not know how we could argue a case before any tribunal. It goes on, further, to say that if a case goes to arbitration the economic circumstances of the country must be considered. There is no dispute between us about the necessity for ensuring that productivity rises at such a rate that increased salaries can be paid. It is the stupidity of the application of that principle which baffles us, the blanketing in such a stupid form to embrace everyone, however justified or unjustified it may be.

I want to say a word about this offer that has been made by the Minister. It is rather strange that it comes nine-and-a-half months after the claim and he graciously permits both sides to talk again. When he was speaking I was reminded of one of the Books of the Apocrypha, The Book of the Secrets of Enoch. If my memory serves me aright—it is a long time since I read the Apocrypha—Enoch was to divide us into seven compartments. It is not really relevant, but I remember that in the second one there were to be herded the fallen angels. I should imagine from what the Tory Press is saying today that the Leader of the House would be high on the housing list.

I should like to probe some of the secrets which lie behind the Minister's
1043
offer. When he talks about the renewed Whitley Council negotiations, does he mean that he is prepared to approve a negotiated settlement if both sides agree to it? Can the right hon. Gentleman tell us that if an agreement should be reached on both sides he will approve it? Secondly, what is meant by phasing? I have heard a lot about phasing I went through the Guillebaud exercise. What does he mean by phasing; how long? Could he tell us if he will ensure that it will last no longer than six months? Is the phasing to be decided by the Whitley Council or by the Minister?

These are questions which ought to be answered tonight. The Minister spoke of various financial limits within which increases and regrading would be considered. Are those fixed yet? What are the figures? Who fixes them? Does the Minister mean that the first phase will be limited to an increase of 2½ per cent. overall, or is this negotiable? If the 2½ per cent. is the first phase, perhaps we may be told tonight for how long it is to be. Further, to what extent will the management side be required to consider the Government's incomes policy and to negotiate within it?

Also, if the case goes to the Industrial Court, will arbitration be unfettered and free, and will the award be binding on the Minister? This is the test of the honesty of the move made this afternoon by the Minister. If there is to be a review, will he accept the agreement, if such there be, between both sides? If it has to go to the Industrial Court, will he pledge the Government that they will accept the outcome?

The plain truth is that the blanket operation outlined in the White Paper is now in tatters. The Government have been obsessed by arithmetic. They have imagined that, in so complicated a wage and salary structure as we have in this country, ignoring the differences between the different professions and sets of workers, they could lay down a common pattern.

We do not dispute that there must be an increase in productivity before we can pay ourselves more. But where we are going wrong is that we are arguing about 2½ per cent., taking it as the guiding light, when the priority should
1044
be on the first part of the sentence in the White Paper, on an increase in productivity. The Government's every effort at this time should be on increasing productivity within industry so as to restore confidence in the minds of the workers, enabling us to get on with the job. The Prime Minister and the Chancellor have their priorities wrong. Sometimes, it seems that the Chancellor is shrinking from the immediate task, shrinking from any policy to restore confidence within industry. It is as though, as a Member of the House, he had a lovely girl cuddled in his arms, and he was thinking how to win the next General Election instead of keeping his mind on the immediate task in hand. He really ought to get on with the job.

The Tory Press is talking about the need for a reshuffle and the need to bring life back to the Tory Party. If this is to be done, it is said, there must be new faces and a new vigour. The reservoir upon which the Prime Minister can draw is no more than a little pool. It is obvious that, in their handling not only of nurses' pay but of other matters relating to the pay pause, the Government have lost the confidence of the country. The series of local government elections during the past week have revealed that not only is their insensitiveness criticised, but their incompetence in handling the affairs of the nation has earned them rejection by the people. The Government ought seriously to consider their position. Instead of a reshuffle, they should consider whether it is their duty now to leave matters for other hands to take over.

The Minister of Health, I understand, is a great student of Greek history. I can only suggest to him that perhaps the qualities which made him such are not the most useful in determining policy in this matter. He has argued forcefully and subtly that any question of staffing is irrelevant, that he has enough staff, and that the salaries of nurses cannot be related to a shortage of labour in the profession. This matter goes beyond the normal arguments in industry about whether there is a shortage of labour, about comparability, and so on.

The right hon. Gentleman ought now to declare that there should be an immediate increase for the nurses and, if necessary, that a review should follow.
1045
Undoubtedly, within the salary structure of the nurses there is room for review. It may well be that there should be a revaluation of certain scales and existing differentials. I plead with the Government now to give a message of justice to the nurses at once and then proceed with the review.

The right hon. and learned Member for Hertfordshire, East (Sir D. Walker-Smith) made a speech which showed much good sense. If I may say so, with kindly intent, the right hon. and learned Gentleman would appear sometimes to be a better ex-Minister of Health than he was a Minister. He is quite right in asserting that the nurses cannot be left as the victims of those who, because of their industrial strength, are able to go forward, covered, as it were, by the big battalions. He was quite right in his submisson that we have to proceed to a stage when these various sections of our community can be dealt with in justice.

I conclude by making my confession now. I am one of those who believe that in the end there must be a rational incomes policy. I do not believe that we can go on in the present way. For ten long years the unions, the employers and the Government have been snarling at one another, angry with one another, each indicting the other with every sin in the calendar I submit that it is not good enough and that the people who are the victims of that snarling are those whom we are debating today.

I hope that there will be some constructive thinking from the Government benches on how we might proceed to a rational policy. But the immediate task is to give justice to the nurses in the form of an immediate offer of what I hope is not less than 5 per cent. or 6 per cent., and then to proceed to an inquiry into their wages structure so that the differential can be properly evaluated.

I therefore submit to the Minister that we are entitled to a proper reply tonight so that justice can be done to those who deserve it.

The hon. Member for Southwark (Mr. Gunter) started by saying that as a Welshman he was not afraid of emotion. Nor am
1046
I. In the world in which we live it seems to me that it becomes all of us, on whatever side of the Committee we sit, to learn all we can about the facts of life, both within this country and outside. But I entirely agree that it is a sign of any mature community that it reacts emotionally to much that happens and I certainly would make no apology at all for reacting strongly on some important issues.

I must, however, take up the hon. Member on one point. I do not believe there is any reason at all for us on this side of the Committee to apologise for the fact that, as compared with ten or fifteen years ago, far more people in this country than before own such things as cars and television sets. [An HON. MEMBER: "What about the nurses?"] I shall have plenty to say about the nurses. All I am saying is that I can see nothing wrong at all in the fact that today so many families in this country enjoy freedom that was enjoyed by far fewer families generations ago.

At the same time, let us remember that this greater affluence at home has not been accompanied by any neglect of the public services during the past ten years. We devote today a larger proportion of the national income to the public services than ten years ago. Expenditure on social services has gone up about 50 per cent. during our term of office. I cannot agree with what was said on the other side of the Committee about values today. On the contrary, there are very many people in all political parties who mind just as much as the hon. Member does about the sort of objectives that we have been considering in this debate.

I fully realise that in the minds of many hon. Members this has been more than an ordinary Supply Day debate, and, although the subject of this debate—the pay of nurses and midwives—is in itself a relatively limited one, it raises the whole question of the Government's incomes policy, and that is why it falls to me to reply this evening.

The hon. Member for St. Pancras, North (Mr. K. Robinson), who opened the debate, based a large part of his speech on the assurance that the Government's incomes policy—I quote his words—"was in ruins". Let me make it
1047
absolutely clear that the Government have no intention whatever of surrendering the principle of the incomes policy.

I shall have a lot to say to the hon. Member for Ebbw Vale (Mr. M. Foot) and other hon. Members about practice.

As my right hon. Friend the Minister of Health said, the basic proposition of the Government's incomes policy cannot be challenged. In the first place, as my right hon. Friend pointed out, if we have a rise in incomes outstripping production this is a consequence from which all suffer and not least the professions, which will always lose the race in an inflationary scramble. Secondly, after listening to today's debate, I wonder whether even now hon. Members fully realise just how closely the incomes policy is bound up with the objective of a faster rate of economic growth, which is supported on both sides of the Committee. I was very glad, listening to the hon. Member for Southwark's thoughtful speech, to find that he does not in principle condemn the idea of incomes policy.

Judging from the weekend Press, there has been a widespread welcome for the decision of the National Economic Development Council to consider the implications of an annual rate of growth of 4 per cent. over a period of five years.

If we are to achieve a steady rate of growth of this order, there can be no possible doubt about the relevance of a policy designed to keep increases in personal incomes in step with the growth of national production. Hon. Members may recall that the Government's White Paper on Incomes Policy: The Next Step concluded with this very point:
The Government reaffirm that their policy is one of securing faster economic growth. But this can only be achieved if we can introduce greater realism into what we as a nation do about incomes.
Exactly the same point was made in the O.E.C.D. Economic Survey, which was quoted by so many hon. and right hon. Members opposite during the Budget debate.

I would remind the Committee of what was said in the concluding paragraphs of that Report:
1048The Government's policies in respect of incomes and profits are thus of cardinal importance for the future expansion of the economy… If steps can be taken to improve the competitive situation and prevent money incomes rising too fast thereafter, the United Kingdom economy should be in a position to embark on a process of more adequate and steady growth than in the past.
In fact, the whole theme of the O.E.C.D. Report, repeated again and again, especially in the concluding paragraphs, is that we have to improve our international competitive position if we are to achieve a steady and continuing rise in exports as the major dynamic element in new economic growth. The only way for any country to improve its international competitive position is to keep production costs steady by ensuring that money incomes rise no more than the growth of productivity over the economy as a whole.

I have a great deal to say about the nurses. I am coming to that subject. There is, however, one other general point I should like to make. A great deal has been said about fairness in today's debate. [Interruption.] The points I have been making are extremely relevant to the community and to the social services as well.

We will not take it as read because, while the hon. Member for Nelson and Colne (Mr. S. Silverman) is good at speaking and intervening, it is sometimes the case that we have to repeat points to the hon. Member quite often. A great deal has been said about fairness in the course of today's debate. None of us is going to under-rate the importance of the Government dealing fairly with individuals, and, indeed, I shall have more to say about this in my speech.

It seems to me that a great many hon. Members miss one very crucial point, namely that it would be quite possible—even easy—for a Government to take a number of decisions which seemed fair to those immediately concerned but which, collectively, worked out very unfairly from the point of view of the community as a whole. Fairness to individuals, bought at the cost of a steadily
1049
falling value of money and a consistently lower rate of growth of the economy than we could otherwise have achieved, is not fairness at all.

No one doubts, least of all hon. Gentlemen opposite, that there are aspects of our national life in regard to which the Government must represent not the interests of any particular group within our society, but rather the public interest—the interest of the community as a whole. I believe that this is especially true where incomes policy is concerned. [HON. MEMBERS "What about the White Paper?"] It is no good hon. Gentlemen opposite quoting that document where it suits them and denying it where, for political reasons, it does not.

It is not good enough to say, as the hon. Member for Cardiff, South-East (Mr. Callaghan) said in the Budget debate, that the incomes policy might be an idea but that this Government could not do anything about it. I know that that is the hon. Gentleman's view and I am taking this opportunity of replying to it. Whoever governs this country will have to grapple with this problem of personal incomes in the private and public sector, and hon. Gentlemen opposite make a great mistake if they suppose that it would be so much easier for them than it is for ourselves.

Past experience of Labour Governments does not suggest that this is true. If any hon. Gentleman opposite wishes to dispute this, let him, for example, refresh his memory of what was said at the Conference of Shipbuilding Unions in 1951, almost on the very day that the Labour Government published their White Paper on Dividend Limitation. The truth is that no Government can escape the economic implications of full employment. Since the war, a large proportion of the community has come to accept it as natural and right that their money incomes should increase substantially, year after year, quite irrespective of Britain's competitive position relative to that of other trading nations.

It is this state of affairs which needs to be brought to an end if we want to achieve a steady rate of growth and if Britain is to play her full part as a member of the Western Alliance. I do not think we ought to underestimate what has been achieved in this direction in the past nine months. The pay pause introduced by my right hon. and learned
1050
Friend last July met with a considerable measure of success and has achieved a good deal to strengthen our competitive position. A large part of its success lay, I believe, in the attention which it focused on the whole problem of incomes and the more widespread appreciation it secured of the underlying causes of our difficulties.

Indeed, I have little doubt that the February White Paper on incomes policy, designed to deal with the period after the pay pause came to an end on 1st April, commanded a very much wider measure of support and understanding than many of the Government's critics have suggested.

I say that the hon. Gentleman's Government cannot deal with the matter—[HON. MEMBERS: "Question."] I assure the hon. Gentleman that his Government cannot deal with the matter because they have behaved so unfairly towards Government servants and at the same time have given away £83 million in Surtax. This is the basic reason

Shut up. This is the basic reason why the Government are quite unable—

Hon. Members

Speech.

The Chairman (Sir William Anstruther Gray)

Order. I hope that the Committee will remember our procedure. An hon. Member from the Opposition Front Bench sought to interrupt the Minister who was replying, and the Minister saw fit to give way. It is up to the Committee to allow the hon. Gentleman to make his point, but not at too great a length.

I entirely agree, Sir William. Since the Financial Secretary is making the speech which he wanted to make in reply to what I said during the Budget debate, may I say this? I beg him to persuade his colleagues of this.
1051
When he begins to behave fairly with all sections of the community, the Government will have the chance to introduce a proper incomes policy. But as long as they give away £83 million in Surtax, they will find it impossible to do that.

First, I have dealt at some length with the incomes policy because I understood that it was the wish of both sides of the Committee that a Treasury Minister should wind up the debate. A number of hon. Members have raised this subject, and I think that The Times was perfectly right when it said in its leading article this morning that those who criticise the Government on the subject of nurses' pay are really criticising the Government's incomes policy. I therefore make no apology for having devoted some time in my speech to that subject.

In answer to the hon. Gentleman's second point, he and I have often discussed the distribution of the national income in Budget debates. When we consider general rises in living standards, improvements in the social services and general movements of incomes over the last twelve years, I disagree with the hon. Gentleman that the Government are not entitled to introduce this policy.

Finally, on the Surtax point, I do not believe that any Labour Government before the war would have levied Surtax on someone earning £700 a year, which is the monetary equivalent of £2,000 today. That is my answer on the subject of Surtax.

At this point, I wish to make the Government's views clear with regard to the dock settlement, which was raised in a number of speeches. The Government's view with regard to wage increases remains exactly as it was stated in paragraph 5 of the White Paper. I remind the Committee of these sentences:
In recent years national production per head has risen by about 2 to 2½ per cent. a year. … It is accordingly necessary that the increase of wages and salaries, as of other incomes should be kept within this figure during the next phase. It follows that there is no scope in 1962 for more than strictly limited increases in wages and salaries".
Since I believe that there is still misunderstanding about this, I remind the Committee that the figure of 2 to 2½ per cent. deliberately related to the increase in national production which we have
1052
achieved in recent years. There are sound reasons for hoping that we shall achieve a higher increase in production than 2½ per cent. during the present financial year. Provided we keep our costs steady, there is no reason why this trend should not be continued, but we must earn this increased production and have reasonable prospects of maintaining it over a longer period before we can safely afford a higher rate of annual increase for personal incomes as a whole.

Returning to the dock settlement, the implications of the Government's incomes policy were fully understood by the port employers, who have themselves made this quite plain publicly. What the Government find to criticise in the terms of the settlement is that they went clearly beyond Government policy as laid down in Paragraph 5 of the White Paper, but I emphasise that there is no question of the Government's abandoning their incomes policy, which remains essential both for Britain's competitive performance in world markets and to rising living standards for the British people. I repeat: the whole standard of life and the whole policy of our society will depend upon the principles behind the Government's incomes policy being more and more widely understood.

I now come to the nurses' and midwives—the principle subject of the debate. [HON. MEMBERS: "Hear, hear."] It is all very well for hon. Members opposite to shout. I make no complaint of that. But the whole point of my remarks has been—and they know this as well as I do—that the pay of nurses and midwives cannot be considered in isolation from the general incomes policy of the Government. If the Government are to pursue a serious incomes policy they cannot ignore that policy in dealing with the pay of the public servants who are in sectors of the economy that the Government control or influence. That point was brought out well in the extremely good and helpful speech of my hon. Friend the Member for Ashford (Mr. Deedes).

He has been here for the greater part of the debate, which is more than some hon. Members can say who have been interrupting during the last half hour.

1053
When the nurses submitted a substantial pay claim my right hon. Friend the Minister of Health was bound to consider it against the background of the February White Paper, which stated that, for the time being, increases in wages and salaries ought to be kept within the level of 2–2½ per cent. My right hon. Friend has explained very fully to the Committee the considerations which led the Government to the view that they would not be justified in placing the nursing profession right outside the ambit of the incomes policy.

I listened to a number of speeches today, including that of the hon. Member for Edmonton (Mr. Albu) who made the point that people in the public sector do not like to feel themselves the instrument of government policy. I entirely appreciate that point, but let us remember that if we want to see a fostering of the public services, and want to see those services developing as they should, I do not believe that these public servants can be left out of the ambit of incomes policy altogether. We cannot leave it out of the reckoning that nurses received a pay increase ranging between 5 per cent. and 25 per cent. in 1959, with an additional 5 per cent. increase in December. 1960. Also, as my right hon. Friend has shown very clearly in successive debates, recruitment is buoyant, and the staffing position stronger than it has ever been. That is true, in general.

In those circumstances it is hard to see how the Government could plausibly maintain that nurses ought to be regarded as meriting quite different treatment from other groups. Many hon. Members will by now have read the leading article in this morning's The Times, which I thought both fair and helpful on this point. I wish to quote a part of it. It said:
Any quarrel with nursing policy is really a quarrel with the general policy concerning incomes set out in the White Paper. That document discredited the idea that cost of living trends, labour shortages, or comparability' could automatically justify increases. It also emphasised that the amount of money involved must be considered. Nurses' salary is already a major item in the cost of the hospital service. To have conceded to the full the ambitious claims for increases … would have cost, it has been estimated, about £54 million a year. No Government advocating restraint could be expected to regard that prospect with equanimity. An overall rise of 2½ per cent. (costing £4 million) is another matter.1054
In this context one has to remember the very major programmes which my right hon. Friend has introduced for the expansion of the hospital service, and I believe that both from the point of view of total cost and from the point of view of incomes the leading article of The Times has a great deal which the Committee should consider. Of course the Government realise that an absolutely flat level of pay increases is not something that could be maintained in the longer term. It would not be fair to individuals. I admit that this has been said before, and I am glad that a right hon. Gentleman opposite appears to be pleased to hear it again. It would not be sound economics nor conducive to the sort of society which all of us here would wish to see.

No one can say that the pay of nurses as a whole ought for all time to remain fixed. [Interruption.] I made exactly the same point when I was speaking in the Budget debate and I am glad that at any rate hon. Members have got it now. No one is saying that the pay for nurses should at all times remain fixed in the present relationship to other occupations. Certainly the pay structure deserves careful study and reconsideration. We had a good speech on this subject from my hon. Friend the Member for Holborn and St. Pancras, South (Mr. G. Johnson Smith). In the long term an incomes policy, if it is to commend itself to the nation, must contain provisions for adjustments of this sort, and I am sure that the Committee will have been glad to learn of the management side's proposals that an examination of the different possibilities, within the various limits of cost, should be undertaken at once by the Whitley Council.

In answer to my hon. Friend the Member for Tynemouth (Dame Irene Ward), whose speech I am sorry I missed this afternoon, I can say that the limits of cost for this purpose would not of course be confined to a total of 2½ per cent. of the salary bill. Much more would be under discussion. As for the letter from the Royal College of Nursing of 10th May, this was necessarily written without knowledge of the management side's approach which was announced by my right hon. Friend the Minister of Health this afternoon.

1055
The hon. Member for Southwark raised two questions. First, he asked about the rate at which any agreement reached could be implemented. This must of course depend on a number of factors, including the development of the Government's incomes policy. As for arbitration, I can give him the answer that if, in a dispute between the nurses and the Government, this were referred to arbitration, the Government would be bound by the findings of the industrial court.

I do not know what the hon. Member means by "interfere". It is essential to the Government's whole policy that the management side, when matters go to arbitration, should have every opportunity of stating what they conceive to be in the public interest. [An HON. MEMBER: "Nobbling the referee."] Not at all. I repeat that it is odd that the party opposite should be so unwilling to contemplate the idea that the Government of the day might sometimes have to stand up for the public interest. But such an examination as my right hon. Friend has proposed is quite a different matter from saying that nurses ought here and now to be given an increase quite different in scale from that which is being given in other parts of the public service.

I should like to say this about the current agitation which is being waged. I do not want to under-rate the strength of public feeling on nurses' pay at this time. The hon. Member for St. Pancras, North talked very fairly on this subject this afternoon, but I do not see how it could possibly be right that the Government should bow to a wave of public opinion, however keenly and sincerely felt, and exempt one group of their employees from an incomes policy which the Government are observing generally and urging on private employers.

If the hon. Member is referring now to the question of arbitration—[HON. MEMBERS: "No."]—if, as I thought, he is talking about agreement, the Government have made their views quite clear about the 2½ per cent. at the present time. Therefore, any question of any increase over and above 2½ per cent. could not be implemented at the present time. [HON. MEMBERS: "oh."] That is absolutely clear in what I said, but if the hon. Gentleman is referring to arbitration, then any results of arbitration would be binding on the Government.

It is necessary to get this clear. A review will be undertaken, and if in the end the management and staff sides agree on a reconstruction and improvement, is the hon. Gentleman saying that the award cannot be one of more than 2½ per cent.?

I cannot say. I have already said that this will depend on the development of the Government's incomes policy, and must depend on economic circumstances at the time.

The right course, in the Government's view, is to regard nurses as falling within the scope of the White Paper, but to give the Whitley Council every encouragement to carry out a constructive review of the pay structure of the profession. As my right hon. Friend said, any resultant agreement would no doubt have to be implemented by stages, but the creative work of carrying out the review could start straight away.

In the conduct of our incomes policy we have to arrive at some means of providing for the special circumstances in which a case can clearly be made for a divergence from the general rule, but it is equally essential to ensure that what is designed to be a change in relativities between one group of people and another achieves its object of being simply a change in relativities. We must avoid returning to a situation in which what is done under special circumstances for a limited number of wage or salary earners automatically sets the pattern for what
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is expected by those working in other sectors of the economy where there is nothing like the same justification, either on economic or social grounds. If hon. Gentlemen opposite do not agree with that, let them look at the fifth chapter of the O.E.E.C. Report on prices which shows exactly how the competitive power of the British economy has been handicapped during the 'fifties by this tendency for certain wage claims to be copied and repeated by other parts of the economy where there was not the same justification.

This is very important. The hon. Gentleman has said two things. First, that if there is an agreement to pay more than 2½ per cent., he will not implement it. Secondly, if the arbitrators say that there is a case for more than 2½ per cent., he will implement it. If 2½ per cent. is so vital to his incomes policy, why is he content to be bound by the award of the arbitrators but not content to be bound by agreement between the two sides?

The White Paper made it plain that the Government were going back to the position that prevailed before 25th July about arbitration, except that there was to be no retrospection to a date before 1st April. I have said, and I repeat, and this must be the last time that I make the point, that the examination to which my right hon. Friend referred of the whole pay structure would not be limited to 2½ per cent. on the bill, but that this must be implemented in stages. I see nothing inconsistent in holding both those views.

My final point is that if we can succeed in strengthening the competitive power of our economy this will have notable consequences for the whole of our national life. When we are considering the benefits of economic growth, it is natural that we should think first of the increased freedom of choice and of opportunity enjoyed by individuals, but a steady rate of growth would have notable consequences for our public services as well.

Even the rate of growth that we achieved in the 'fifties has meant that in real terms the standards of many of our public services have risen considerably, and the plans which the Government have already announced, like
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my right hon. Friend's hospital programme, show that they intend this advance to continue.

It is because the Government realise the crucial importance for everyone in Britain of holding costs steady that they intend not only to pursue their present policies but also to do all they can to foster a wider understanding throughout the community of the problems we have been considering today.

The Government are in no doubt as to the course they ought to pursue in the interests of the nation as a whole. They will not be deterred by the fact that no economic policy which must depend in considerable measure on the support of those who are free agents in their own right can achieve complete and uniform success. But the important point is that my right hon. and learned Friend the Chancellor by his firm budgetary policies, by his decision to set up a National Economic Development Council and by his courage in grappling with the root cause of all our inflationary troubles has already made a contribution to Britain's future economic well being, the magnitude of which, provided that these policies are firmly adhered to, will become even more apparent with the passage of time. I say that in the knowledge that the benefits will be apparent not only to individuals in this country but to those who are concerned with the public services and who wish, as all of us in the House do, to achieve social services in this country of which everyone, of all parties and none, can rightly be proud.

In opening the debate for the Government, the Minister of Health announced the terms of a new initiative by the management side of the Whitley Council. He made his announcement in a passage which was, I believe not accidentally, most obscure.

To elucidate this passage, by hon. Friend the Member for Southwark (Mr. Gunter) asked at least six very pertinent and perfectly reasonable questions. During the course of his winding-up speech, the Financial Secretary to the Treasury, in his usual breezy style, and, judging by most of his remarks, appearing to think that he was winding up an economic debate, replied to some of these questions only under pressure from my hon. Friend. The Financial Secre-
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tary's replies to three of the questions were wholly unsatisfactory. It seems that the more we learn about the new initiative, the less there is likely to be in it for the nurses.

It is for this reason, and to express our dissatisfaction with the Government's